MEDICARE: LITTLE HOUSE PEDIATRICS L.L.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	ME65074	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457691347
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LITTLE HOUSE PEDIATRICS L.L.C.

Provider Business Mailing Address
First Line	:	8734 LEE VISTA BLVD
Second Line	:	SUITE 400
City	:	ORLANDO
State	:	FL
Zip	:	32829-8022
Country	:	US
Telephone Number	:	407-910-2340
Fax Number	:

Provider Business Practice Location Address
First Line	:	8734 LEE VISTA BLVD
Second Line	:	SUITE 400
City	:	ORLANDO
State	:	FL
Zip	:	32829-8022
Country	:	US
Telephone Number	:	407-910-2340
Fax Number	:

Authorized Official
Title or Position	:	MANAGAMENT MEMBER
Name	:	DR. SANTIAGO A. JIMENEZ
Credential	:	M.D.
Telephone Number	:	407-910-2340

Provider Enumeration Date	:	03/01/2013
Last Update Date	:	10/14/2013

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Directions to “LITTLE HOUSE PEDIATRICS L.L.C. ” Practice Location

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