Provider Demographics
NPI:1417112756
Name:KIDZ PEDIATRICS, PA
Entity Type:Organization
Organization Name:KIDZ PEDIATRICS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LOURDES
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-489-5456
Mailing Address - Street 1:285 W DORA ST
Mailing Address - Street 2:
Mailing Address - City:ANGIER
Mailing Address - State:NC
Mailing Address - Zip Code:27501-9542
Mailing Address - Country:US
Mailing Address - Phone:919-639-9995
Mailing Address - Fax:
Practice Address - Street 1:285 W DORA ST
Practice Address - Street 2:
Practice Address - City:ANGIER
Practice Address - State:NC
Practice Address - Zip Code:27501-9542
Practice Address - Country:US
Practice Address - Phone:919-639-9995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-25
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2004 00397208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty