Healthcare Provider Details

I. General information

NPI: 1972806610
Provider Name (Legal Business Name): KIDS FIRST PEDIATRIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2010
Last Update Date: 12/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3447 PINE RIDGE RD STE 101
NAPLES FL
34109-3927
US

IV. Provider business mailing address

3447 PINE RIDGE RD STE 101
NAPLES FL
34109-3927
US

V. Phone/Fax

Practice location:
  • Phone: 239-431-6413
  • Fax: 239-431-6417
Mailing address:
  • Phone: 239-431-6413
  • Fax: 239-431-6417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME-91688
License Number StateFL

VIII. Authorized Official

Name: DR. MARILIZ BORBON BUMGARNER
Title or Position: OWNER
Credential: M.D.
Phone: 239-431-6413