Healthcare Provider Details

I. General information

NPI: 1215427786
Provider Name (Legal Business Name): PBS CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2018
Last Update Date: 02/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 E MONUMENT AVE
KISSIMMEE FL
34741-5761
US

IV. Provider business mailing address

PO BOX 452848
KISSIMMEE FL
34745-2848
US

V. Phone/Fax

Practice location:
  • Phone: 407-350-4138
  • Fax: 321-250-7463
Mailing address:
  • Phone: 407-350-4138
  • Fax: 321-250-7463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateFL

VIII. Authorized Official

Name: HECTOR L RODRIGUEZ JR.
Title or Position: DIRECTOR
Credential: AB
Phone: 407-738-0856