Provider Demographics
NPI:1952602286
Name:ADVANCED PEDIATRICS P A
Entity Type:Organization
Organization Name:ADVANCED PEDIATRICS P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AISHA
Authorized Official - Middle Name:FIRDOS
Authorized Official - Last Name:ASIF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-569-5409
Mailing Address - Street 1:3712 WINTER GARDEN VINELAND RD
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-5483
Mailing Address - Country:US
Mailing Address - Phone:407-656-2229
Mailing Address - Fax:407-656-0998
Practice Address - Street 1:3712 WINTER GARDEN VINELAND RD
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-5483
Practice Address - Country:US
Practice Address - Phone:352-394-7125
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-03
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME131571OtherFLORIDA LICENSE NUMBER
FL003191900Medicaid
FL102155600Medicaid