Provider Demographics
NPI:1083877047
Name:TAMPA BAY PEDIATRICS LLC
Entity Type:Organization
Organization Name:TAMPA BAY PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:M
Authorized Official - Last Name:CARTAYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-743-7879
Mailing Address - Street 1:PO BOX 152682
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33684-2682
Mailing Address - Country:US
Mailing Address - Phone:813-743-7879
Mailing Address - Fax:813-926-5358
Practice Address - Street 1:2302 W DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6406
Practice Address - Country:US
Practice Address - Phone:813-743-7879
Practice Address - Fax:813-926-5358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84690208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL284838OtherAVMED
FL7189416OtherAETNA
FL03286OtherBCBS
FL4137152OtherCIGNA
FLBC7726447OtherDEA
FLBC7726447OtherDEA
FL7189416OtherAETNA