Provider Demographics
NPI:1316183460
Name:OVIEDO CHILDRENS HEALTH CENTER LLC
Entity Type:Organization
Organization Name:OVIEDO CHILDRENS HEALTH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SADIQ
Authorized Official - Middle Name:
Authorized Official - Last Name:MANDANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-977-1135
Mailing Address - Street 1:1410 W BROADWAY ST STE 104
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-6537
Mailing Address - Country:US
Mailing Address - Phone:407-977-1135
Mailing Address - Fax:407-977-9946
Practice Address - Street 1:1410 W BROADWAY ST STE 104
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-6537
Practice Address - Country:US
Practice Address - Phone:407-977-1135
Practice Address - Fax:407-977-9946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-19
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90618208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty