Provider Demographics
NPI:1316385164
Name:RAINBOW PEDIATRICS
Entity Type:Organization
Organization Name:RAINBOW PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PRASANTHI
Authorized Official - Middle Name:
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-223-9100
Mailing Address - Street 1:4788 HODGES BLVD
Mailing Address - Street 2:SUITE B-108
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-7222
Mailing Address - Country:US
Mailing Address - Phone:904-223-9100
Mailing Address - Fax:904-223-9282
Practice Address - Street 1:4788 HODGES BLVD
Practice Address - Street 2:SUITE B-108
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-7222
Practice Address - Country:US
Practice Address - Phone:904-223-9100
Practice Address - Fax:904-223-9282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-13
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME911952080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008830500Medicaid