Healthcare Provider Details

I. General information

NPI: 1437587524
Provider Name (Legal Business Name): OCEAN PEDIATRIC CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2013
Last Update Date: 10/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11026 SPRING HILL DR
SPRING HILL FL
34608-5048
US

IV. Provider business mailing address

11026 SPRING HILL DR
SPRING HILL FL
34608-5048
US

V. Phone/Fax

Practice location:
  • Phone: 352-835-7111
  • Fax: 352-835-7110
Mailing address:
  • Phone: 352-835-7111
  • Fax: 352-835-7110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME105372
License Number StateFL

VIII. Authorized Official

Name: EID GUIRGUIS
Title or Position: PRESIDENT
Credential: MD
Phone: 352-835-7111