Provider Demographics
NPI:1609151315
Name:KIDS DOC PEDIATRICS
Entity Type:Organization
Organization Name:KIDS DOC PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:E
Authorized Official - Last Name:SCACCABARROZZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-332-4400
Mailing Address - Street 1:6440 W NEWBERRY RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4381
Mailing Address - Country:US
Mailing Address - Phone:352-332-4400
Mailing Address - Fax:
Practice Address - Street 1:6440 W NEWBERRY RD
Practice Address - Street 2:SUITE 105
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4381
Practice Address - Country:US
Practice Address - Phone:352-332-4400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-13
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty