Healthcare Provider Details

I. General information

NPI: 1669432134
Provider Name (Legal Business Name): ALTAMONTE PEDIATRIC ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 05/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 OSCEOLA ST SUITE 1100
ALTAMONTE SPRINGS FL
32701-7857
US

IV. Provider business mailing address

475 OSCEOLA ST SUITE 1100
ALTAMONTE SPRINGS FL
32701-7857
US

V. Phone/Fax

Practice location:
  • Phone: 407-831-6200
  • Fax: 407-831-1068
Mailing address:
  • Phone: 407-831-6200
  • Fax: 407-831-1068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. WAYNE SOVEN
Title or Position: VICE PRESIDENT
Credential: M.D.
Phone: 407-831-6200