Fortunato, Diane L

Fortunato, Diane L is an sole proprietor health care provider with primary practice located at 2412 Quirt Ln , Punta Gorda FL 33983-2627. She recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as her primary health care specialty. Fortunato, Diane L can be contacted via phone (941) 764-9480.

Contact Information

Primary practice address
2412 Quirt Ln Punta Gorda FL 33983-2627
Phone: (941) 764-9480
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 25MA04648600 New Jersey
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 63562 Florida

Profile Details

NPI number 1053313718
LBN Legal business name Fortunato, Diane L
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Aug 12th, 2005
Last updated Jun 19th, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1053313718 NPPES
New Jersey MEDICAID 1868501

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