Healthcare Provider Details

I. General information

NPI: 1245218197
Provider Name (Legal Business Name): MCH PEDIATRIC CARDIOLOGY,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2006
Last Update Date: 05/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 W. STUTERVANT STREET
ORLANDO FL
32806
US

IV. Provider business mailing address

PO BOX 557367
MIAMI FL
33255-7367
US

V. Phone/Fax

Practice location:
  • Phone: 407-649-6907
  • Fax: 407-481-2035
Mailing address:
  • Phone: 305-662-8301
  • Fax: 305-662-8304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. PEDRO ALFARO
Title or Position: SENIOR VP & CFO
Credential:
Phone: 305-666-6511