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KIDSVILLE PEDIATRICS IV P.A. NPI 1508955212


NPI Information

NPI: 1508955212
Provider Name: KIDSVILLE PEDIATRICS IV, P.A.
Classification: Pediatrics - 208000000X
Entity Type: Organization

CLIA Number: 10D1058612

Address:
11886 LAKE UNDERHILL RD
ORLANDO, FL
ZIP 32825
Phone: (407) 447-7773
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KIDSVILLE PEDIATRICS IV, P.A. is a pediatrics in Orlando, FL. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. KIDSVILLE PEDIATRICS IV, P.A. NPI is 1508955212. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

11886 LAKE UNDERHILL RD
ORLANDO, FL
ZIP 32825-436
Phone: (407) 447-7773
Fax: (407) 447-7804

The provider's authorized official is Francelis I. Gonzalez .
The authorized official title is Ceo and has the following contact phone number (407) 447-7773.

The CLIA number assigned to this NPI record is 10D1058612 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/12/2006 and was last updated on 8/13/2019.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1208000000XPediatricsME-0074421FLORIDAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1274349300MEDICAIDFLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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