Healthcare Provider Details

I. General information

NPI: 1922761097
Provider Name (Legal Business Name): TRUCARE PEDIATRICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2021
Last Update Date: 11/15/2023
Certification Date: 11/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 BABCOCK ST NE STE 302
PALM BAY FL
32905-4648
US

IV. Provider business mailing address

5200 BABCOCK ST NE STE 302
PALM BAY FL
32905-4648
US

V. Phone/Fax

Practice location:
  • Phone: 321-285-7212
  • Fax: 321-250-2038
Mailing address:
  • Phone: 321-285-7212
  • Fax: 321-250-2038

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. ERIKA DIOGENE
Title or Position: PHYSICIAN
Credential: DO
Phone: 321-285-7212