Organization
THERESA FORTALEZA-DAWSON MD PA
Active
Other names
Internal Medicine & Geriatric Health
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THERESA FORTALEZA-DAWSON M.D. (OWNER)
(954) 938-8998
Entity
Organization
Contact information
Practice address
2006 NE 49TH ST, FT LAUDERDALE, FL 33308-4524
(954) 938-8998
(954) 938-8984
Mailing address
6278 N FEDERAL HWY, SUITE 183, FT LAUDERDALE, FL 33308-1916
(954) 938-8998
(954) 938-8984
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
ME81298
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03018
BLUE CROSS BLUE SHIELD
FL
05
—
268019000
—
FL
01
—
280599
AVMED
FL
01
—
50293
NEIGHBORHOOD HEALTH
FL
Enumeration date
06/26/2007
Last updated
01/24/2013
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