Provider Demographics
NPI:1093955940
Name:LEE VISTA PEDIATRICS
Entity Type:Organization
Organization Name:LEE VISTA PEDIATRICS
Other - Org Name:MARCIA GAYOSO PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GAYOSO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-208-9870
Mailing Address - Street 1:815 WOODBURY RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-4515
Mailing Address - Country:US
Mailing Address - Phone:407-208-9870
Mailing Address - Fax:407-208-9868
Practice Address - Street 1:815 WOODBURY RD
Practice Address - Street 2:SUITE 102
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-4515
Practice Address - Country:US
Practice Address - Phone:407-208-9870
Practice Address - Fax:407-208-9868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-04
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0084749208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty