Provider Demographics
NPI:1659031961
Name:FIRST CHOICE PEDIATRICS, INC
Entity Type:Organization
Organization Name:FIRST CHOICE PEDIATRICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CASSIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTUGAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-249-1234
Mailing Address - Street 1:11513 LAKE UNDERHILL RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-5001
Mailing Address - Country:US
Mailing Address - Phone:407-249-1234
Mailing Address - Fax:
Practice Address - Street 1:501 W STATE ROAD 434
Practice Address - Street 2:
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-2485
Practice Address - Country:US
Practice Address - Phone:407-249-1234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIRST CHOICE PEDIATRICS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-12-28
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy