Basic Information
| Provider Information | |||||||||
| NPI: | 1043514862 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WORLD OF PEDIATRICS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 327 W CYPRESS ST | ||||||||
| Address2: | |||||||||
| City: | KISSIMMEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347413326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4074830672 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4151 HUNTERS PARK LN | ||||||||
| Address2: | SUITE 116 | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328373617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4074830672 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2011 | ||||||||
| LastUpdateDate: | 02/01/2011 | ||||||||
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| AuthorizedOfficialLastName: | GARGIULO | ||||||||
| AuthorizedOfficialFirstName: | JANETTE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRACTICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4073986470 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | ME99347 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 3832208 | 05 | TN | MEDICAID |