Healthcare Provider Details

I. General information

NPI: 1871861229
Provider Name (Legal Business Name): AMAZON PEDIATRICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4075 PINE RIDGE RD STE 2
NAPLES FL
34119-4004
US

IV. Provider business mailing address

4075 PINE RIDGE RD SUITE #2
NAPLES FL
34119
US

V. Phone/Fax

Practice location:
  • Phone: 239-963-9855
  • Fax: 239-963-9857
Mailing address:
  • Phone: 239-963-9855
  • Fax: 239-963-9857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LETICIA MENDEZ
Title or Position: PRESIDENT
Credential:
Phone: 239-963-9855