Provider Demographics
NPI:1720603129
Name:KIDS' CORNER PEDIATRICS
Entity Type:Organization
Organization Name:KIDS' CORNER PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EVER
Authorized Official - Middle Name:I
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-940-8140
Mailing Address - Street 1:1114 BELL SHOALS RD
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-8813
Mailing Address - Country:US
Mailing Address - Phone:813-940-8140
Mailing Address - Fax:813-940-8148
Practice Address - Street 1:1114 BELL SHOALS ROAD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-8813
Practice Address - Country:US
Practice Address - Phone:813-940-8140
Practice Address - Fax:813-940-8148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-11
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty