Healthcare Provider Details

I. General information

NPI: 1396095998
Provider Name (Legal Business Name): PEDIATRIC CARE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2012
Last Update Date: 07/08/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2135 S CONGRESS AVE STE 2C
PALM SPRINGS FL
33406-7611
US

IV. Provider business mailing address

2135 S CONGRESS AVE STE 2C
PALM SPRINGS FL
33406-7611
US

V. Phone/Fax

Practice location:
  • Phone: 561-432-1822
  • Fax: 561-432-0108
Mailing address:
  • Phone: 561-432-1822
  • Fax: 561-432-0108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberME0063404
License Number StateFL

VIII. Authorized Official

Name: ARMANDO GONZALEZ
Title or Position: OWNER/AO
Credential: M.D.
Phone: 561-432-1822