Healthcare Provider Details

I. General information

NPI: 1235271669
Provider Name (Legal Business Name): PEDIATRIC CENTERS OF LEE COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 08/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 PLAZA DR
LEHIGH ACRES FL
33936-6018
US

IV. Provider business mailing address

222 PLAZA DR
LEHIGH ACRES FL
33936-6018
US

V. Phone/Fax

Practice location:
  • Phone: 239-368-5437
  • Fax: 239-369-0880
Mailing address:
  • Phone: 239-368-5437
  • Fax: 239-369-0880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. CARLOS L MORALES
Title or Position: OFFICE MANAGER
Credential:
Phone: 239-278-9983