Healthcare Provider Details

I. General information

NPI: 1801073176
Provider Name (Legal Business Name): T.L.C. PEDIATRICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2008
Last Update Date: 01/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 MOTT AVE
NORWALK CT
06850-3320
US

IV. Provider business mailing address

10 MOTT AVE
NORWALK CT
06850-3320
US

V. Phone/Fax

Practice location:
  • Phone: 203-855-7551
  • Fax: 203-855-7624
Mailing address:
  • Phone: 203-855-7551
  • Fax: 203-855-7624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number037622
License Number StateCT

VIII. Authorized Official

Name: DR. PATRICIA R JORQUERA
Title or Position: PEDIATRICIAN/CO-OWNER
Credential: M.D.
Phone: 203-855-7551