Provider Demographics
NPI:1558648451
Name:MY TAMPA BAY PEDIATRICS, P.A.
Entity Type:Organization
Organization Name:MY TAMPA BAY PEDIATRICS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:ALFARO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-991-7337
Mailing Address - Street 1:PO BOX 89038
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33689-0400
Mailing Address - Country:US
Mailing Address - Phone:813-418-5246
Mailing Address - Fax:813-994-0806
Practice Address - Street 1:26907 FOGGY CREEK RD
Practice Address - Street 2:STE 102
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-6778
Practice Address - Country:US
Practice Address - Phone:813-991-7337
Practice Address - Fax:813-994-0806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-07
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92726208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty