Provider Demographics
NPI:1649483967
Name:INFANT JESUS PEDIATRICS PLC
Entity type:Organization
Organization Name:INFANT JESUS PEDIATRICS PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:GONZALES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-458-1430
Mailing Address - Street 1:505 N 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL
Mailing Address - State:VA
Mailing Address - Zip Code:23860-2618
Mailing Address - Country:US
Mailing Address - Phone:804-458-1430
Mailing Address - Fax:804-458-8857
Practice Address - Street 1:505 NORTH 6TH AVE
Practice Address - Street 2:
Practice Address - City:HOPEWELL
Practice Address - State:VA
Practice Address - Zip Code:23860-2618
Practice Address - Country:US
Practice Address - Phone:804-458-1430
Practice Address - Fax:804-458-8857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101026123208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1891720074OtherDR PATRICIA GONZALES NPI
1538131625OtherDR HERMES DIZON NPI
1538131625OtherDR HERMES DIZON NPI