Provider Demographics
NPI:1922761097
Name:TRUCARE PEDIATRICS LLC
Entity Type:Organization
Organization Name:TRUCARE PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIOGENE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:321-285-7212
Mailing Address - Street 1:5200 BABCOCK ST NE STE 302
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-4648
Mailing Address - Country:US
Mailing Address - Phone:321-285-7212
Mailing Address - Fax:321-250-2038
Practice Address - Street 1:5200 BABCOCK ST NE STE 302
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-4648
Practice Address - Country:US
Practice Address - Phone:321-285-7212
Practice Address - Fax:321-250-2038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-15
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty