Healthcare Provider Details

I. General information

NPI: 1619163359
Provider Name (Legal Business Name): PEDIATRIC SERVICES AND BREATHING CENTER PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2007
Last Update Date: 03/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 N US HIGHWAY 441 STE 940
THE VILLAGES FL
32159-8975
US

IV. Provider business mailing address

1400 N US HIGHWAY 441 STE 940
THE VILLAGES FL
32159-8975
US

V. Phone/Fax

Practice location:
  • Phone: 352-751-4958
  • Fax: 352-751-4959
Mailing address:
  • Phone: 352-751-4958
  • Fax: 352-751-4959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME0081374
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberME0081374
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberME0081373
License Number StateFL

VIII. Authorized Official

Name: JUAN ALBINO
Title or Position: OWNER
Credential: MD
Phone: 352-751-4958