Basic Information
| Provider Information | |||||||||
| NPI: | 1033712203 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FIRST CHOICE PEDIATRICS, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11513 LAKE UNDERHILL RD | ||||||||
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| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328255001 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 N PARK AVE | ||||||||
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| City: | APOPKA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327034148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4072491234 | ||||||||
| FaxNumber: | 4072491755 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2020 | ||||||||
| LastUpdateDate: | 11/19/2020 | ||||||||
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| AuthorizedOfficialLastName: | PORTUGAL | ||||||||
| AuthorizedOfficialFirstName: | ALTAMIRANDO | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 4072491234 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 11/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.