Healthcare Provider Details

I. General information

NPI: 1922400340
Provider Name (Legal Business Name): NORTH NAPLES PEDIATRIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2014
Last Update Date: 09/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9160 GALLERIA COURT
NAPLES FL
34109
US

IV. Provider business mailing address

9160 GALLERIA COURT
NAPLES FL
34109
US

V. Phone/Fax

Practice location:
  • Phone: 239-514-8787
  • Fax: 239-514-1965
Mailing address:
  • Phone: 239-514-8787
  • Fax: 239-514-1965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME0065421
License Number StateFL

VIII. Authorized Official

Name: DR. DINA A BADRA
Title or Position: PHYSICAN
Credential: M.D.
Phone: 239-514-8787