Healthcare Provider Details

I. General information

NPI: 1659031961
Provider Name (Legal Business Name): FIRST CHOICE PEDIATRICS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2021
Last Update Date: 12/28/2021
Certification Date: 12/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 W STATE ROAD 434
WINTER SPRINGS FL
32708-2485
US

IV. Provider business mailing address

11513 LAKE UNDERHILL RD
ORLANDO FL
32825-5001
US

V. Phone/Fax

Practice location:
  • Phone: 407-249-1234
  • Fax:
Mailing address:
  • Phone: 407-249-1234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. CASSIA PORTUGAL
Title or Position: PRESIDENT
Credential: MD
Phone: 407-249-1234