Basic Information
| Provider Information | |||||||||
| NPI: | 1508095175 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LERMONT-ORTIZ | ||||||||
| FirstName: | MEXTLI | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 38135 MARKET SQ | ||||||||
| Address2: | |||||||||
| City: | ZEPHYRHILLS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335427505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8135284975 | ||||||||
| FaxNumber: | 8133555084 | ||||||||
| Practice Location | |||||||||
| Address1: | 6101 WEBB RD | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336152872 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8138888887 | ||||||||
| FaxNumber: | 8132492622 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/04/2009 | ||||||||
| LastUpdateDate: | 03/14/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PA9105035 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | PA9105035 | 01 | FL | MEDICAL LICENSE | OTHER |