Provider Demographics
NPI:1134311640
Name:VOLUSIA PEDIATRICS, LLC
Entity Type:Organization
Organization Name:VOLUSIA PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA-PILCHICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-424-1414
Mailing Address - Street 1:317 SOUTH DIXIE FREEWAY
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-7158
Mailing Address - Country:US
Mailing Address - Phone:386-424-1414
Mailing Address - Fax:386-424-9130
Practice Address - Street 1:317 SOUTH DIXIE FREEWAY
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-7158
Practice Address - Country:US
Practice Address - Phone:386-424-1414
Practice Address - Fax:386-424-9130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-17
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL277882300Medicaid