Provider Demographics
NPI:1629746870
Name:PEDIATRICS OF CENTRAL FLORIDA P.A.
Entity Type:Organization
Organization Name:PEDIATRICS OF CENTRAL FLORIDA P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RUPA
Authorized Official - Middle Name:
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-846-3455
Mailing Address - Street 1:801 W OAK ST STE 101
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-6605
Mailing Address - Country:US
Mailing Address - Phone:407-846-3455
Mailing Address - Fax:407-846-7381
Practice Address - Street 1:11183 S ORANGE BLOSSOM TRL STE C
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-9402
Practice Address - Country:US
Practice Address - Phone:407-857-2816
Practice Address - Fax:407-857-9560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104022200Medicaid