Healthcare Provider Details

I. General information

NPI: 1033712203
Provider Name (Legal Business Name): FIRST CHOICE PEDIATRICS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2020
Last Update Date: 11/19/2020
Certification Date: 11/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N PARK AVE
APOPKA FL
32703-4148
US

IV. Provider business mailing address

11513 LAKE UNDERHILL RD
ORLANDO FL
32825-5001
US

V. Phone/Fax

Practice location:
  • Phone: 407-249-1234
  • Fax: 407-249-1755
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ALTAMIRANDO PORTUGAL
Title or Position: CFO
Credential:
Phone: 407-249-1234