1619358231 NPI number — OVIEDO PEDIATRICS PLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619358231 NPI number — OVIEDO PEDIATRICS PLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OVIEDO PEDIATRICS PLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619358231
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/10/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2959 ALAFAYA TRL
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
OVIEDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32765-9482
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-366-3321
Provider Business Mailing Address Fax Number:
407-359-7616

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2959 ALAFAYA TRL
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
OVIEDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32765-9482
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-366-3321
Provider Business Practice Location Address Fax Number:
407-359-7616
Provider Enumeration Date:
06/10/2015

Additional Information

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
MARIA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
407-366-3321

Provider Taxonomy Codes

  • Taxonomy code: 2080A0000X , with the licence number:  0056487 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 061944200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 016781800 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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