Healthcare Provider Details

I. General information

NPI: 1215063821
Provider Name (Legal Business Name): PEDIATRIC HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 03/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5308 S JOHN YOUNG PKWY STE. 200
ORLANDO FL
32839-7362
US

IV. Provider business mailing address

5308 S JOHN YOUNG PKWY SUITE 200
ORLANDO FL
32839-7362
US

V. Phone/Fax

Practice location:
  • Phone: 407-563-2821
  • Fax: 407-240-9508
Mailing address:
  • Phone: 407-563-2821
  • Fax: 407-240-9508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME 62109
License Number StateFL

VIII. Authorized Official

Name: DR. RAZA ALI
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 407-563-2821