Healthcare Provider Details

I. General information

NPI: 1114298601
Provider Name (Legal Business Name): KIDSWOODS PEDIATRICS CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2012
Last Update Date: 01/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1936 LEE RD SUTIE 137
WINTER PARK FL
32789-7229
US

IV. Provider business mailing address

1177 KENWOOD AVE
WINTER PARK FL
32789-2418
US

V. Phone/Fax

Practice location:
  • Phone: 321-207-0623
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME98395
License Number StateFL

VIII. Authorized Official

Name: DR. ZULLY E AMBROISE
Title or Position: OWNER
Credential: MD
Phone: 407-398-6470