Basic Information
| Provider Information | |||||||||
| NPI: | 1316933799 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTRAL FLORIDA PEDIATRIC INTENSVIE CARE SPECIALIST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 844 N THORNTON AVE | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328034003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4078948768 | ||||||||
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| Practice Location | |||||||||
| Address1: | 844 N THORNTON AVE | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328034003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4078948768 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | OTEGBEYE | ||||||||
| AuthorizedOfficialFirstName: | AYODEJI | ||||||||
| AuthorizedOfficialMiddleName: | V | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 4078948768 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0203X | ME58278 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Critical Care Medicine |
No ID Information.