Healthcare Provider Details

I. General information

NPI: 1699572818
Provider Name (Legal Business Name): PEARL PEDIATRIC CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2025
Last Update Date: 02/26/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15528 W COLONIAL DR UNIT B
WINTER GARDEN FL
34787-9577
US

IV. Provider business mailing address

15528 W COLONIAL DR UNIT B
WINTER GARDEN FL
34787-9577
US

V. Phone/Fax

Practice location:
  • Phone: 321-900-0620
  • Fax:
Mailing address:
  • Phone: 321-900-0620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: IFEYINWA UMEH
Title or Position: PRACTICE OWNER
Credential: MD
Phone: 321-900-0620