Provider Demographics
NPI:1013988146
Name:NADAL PEDIATRICS, LLC
Entity type:Organization
Organization Name:NADAL PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FLORENCIO
Authorized Official - Middle Name:
Authorized Official - Last Name:NADAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-655-0292
Mailing Address - Street 1:PO BOX 2715
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33509-2715
Mailing Address - Country:US
Mailing Address - Phone:813-655-0292
Mailing Address - Fax:813-655-4302
Practice Address - Street 1:621 VICTORIA ST
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-4313
Practice Address - Country:US
Practice Address - Phone:813-655-0292
Practice Address - Fax:813-655-4302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-27
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL262330700Medicaid