Healthcare Provider Details

I. General information

NPI: 1932516408
Provider Name (Legal Business Name): CHILDREN'S DOCTORS CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2014
Last Update Date: 07/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

264 DOUGLAS AVE
ALTAMONTE SPRINGS FL
32714-3336
US

IV. Provider business mailing address

855 E SANDPIPER ST
APOPKA FL
32712-2903
US

V. Phone/Fax

Practice location:
  • Phone: 407-862-8448
  • Fax:
Mailing address:
  • Phone: 407-889-3175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License NumberME29981
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License NumberME29981
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License NumberME29981
License Number StateFL

VIII. Authorized Official

Name: DR. PANITDA D TOOCHINDA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 407-913-2156