Healthcare Provider Details

I. General information

NPI: 1417935362
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: 06/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 W.MILLER STREET
ORLANDO FL
32806-2022
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:
  • Fax:

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 SVP & CFO
Credential:
Phone: 305-669-6422