Provider Demographics
NPI:1619163359
Name:PEDIATRIC SERVICES AND BREATHING CENTER PA
Entity Type:Organization
Organization Name:PEDIATRIC SERVICES AND BREATHING CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALBINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-751-4958
Mailing Address - Street 1:1400 N US HIGHWAY 441 STE 940
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32159-8975
Mailing Address - Country:US
Mailing Address - Phone:352-751-4958
Mailing Address - Fax:352-751-4959
Practice Address - Street 1:1400 N US HIGHWAY 441 STE 940
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32159-8975
Practice Address - Country:US
Practice Address - Phone:352-751-4958
Practice Address - Fax:352-751-4959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-17
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0081374207RP1001X, 207RS0012X
FLME00813732080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL45615Medicare PIN