THERESA FORTALEZA-DAWSON MD PA
Osteopathic Medicine at 49 St, Fort Lauderdale, FL

License number
Florida ME81298
Category
Osteopathic Medicine
Type
Geriatric Medicine
Owner
Name: DR. THERESA FORTALEZA-DAWSON M.D.
Title: OWNER
Phone: (954) 938-8998
Address
Address
2006 NE 49Th St, Fort Lauderdale, FL 33308
National Provider ID: 1144426040
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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THERESA FORTALEZA-DAWSON, M.D., PA

Fort Lauderdale, FL

Status:
Inactive
Inactive reason:
NAME CHANGE AMENDMENT
Registration:
May 29, 2003
Inactive since:
Aug 11, 2003
Addresses:
1880 E Commercial Blvd #3, Fort Lauderdale, FL 33308 (Physical)
6278 N Federal Hwy 183, Fort Lauderdale, FL 33308 (Mailing)
6278 N Federal Hwy, Fort Lauderdale, FL 33308
2008 NE 49 St, Fort Lauderdale, FL 33308
State ID:
P03000061456
Business type:
Florida Profit Corporation
Directors:
Fortaleza-Dawson, Theresa Rmd, 6278 N Federal Hwy #183, Fort Lauderdale, FL 33308 (Physical),Theresa R. Fortaleza-Dawson (Director)
Agent:
Christopher Niles,2601 E Oakland Park Blvd STE 400, Fort Lauderdale, FL 33306 (Physical)
EIN:
54-2122302

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