Healthcare Provider Details

I. General information

NPI: 1194965681
Provider Name (Legal Business Name): GUARDIAN ANGEL PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2009
Last Update Date: 05/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5220 4TH AVENUE CIR E
BRADENTON FL
34208-5621
US

IV. Provider business mailing address

5220 4TH AVENUE CIR E
BRADENTON FL
34208-5621
US

V. Phone/Fax

Practice location:
  • Phone: 941-747-0373
  • Fax: 941-747-0336
Mailing address:
  • Phone: 941-747-0373
  • Fax: 941-747-0336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number61174
License Number StateFL

VIII. Authorized Official

Name: DR. CHANDRA ROBINSON WILLIAMS
Title or Position: OWNER
Credential: M.D.
Phone: 941-747-0373