Healthcare Provider Details

I. General information

NPI: 1801955174
Provider Name (Legal Business Name): FIRST CHOICE PEDIATRICS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 07/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1651 N SEMORAN BLVD
ORLANDO FL
32807-3575
US

IV. Provider business mailing address

1651 N SEMORAN BLVD
ORLANDO FL
32807-3575
US

V. Phone/Fax

Practice location:
  • Phone: 407-249-1234
  • Fax: 407-249-1755
Mailing address:
  • Phone: 407-249-1234
  • Fax: 407-249-1755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. CASSIA PORTUGAL
Title or Position: PRESIDENT
Credential: M.D.,FAAP
Phone: 407-249-1234