Healthcare Provider Details

I. General information

NPI: 1295945798
Provider Name (Legal Business Name): RIGHT FROM THE START PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9423 HOLY CROSS LN SUITE 111
BREESE IL
62230-3510
US

IV. Provider business mailing address

9423 HOLY CROSS LN SUITE 111
BREESE IL
62230-3510
US

V. Phone/Fax

Practice location:
  • Phone: 618-526-8850
  • Fax: 618-526-8852
Mailing address:
  • Phone: 618-526-8850
  • Fax: 618-526-8852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. DANIEL ROCCO MORRA
Title or Position: PRESIDENT
Credential: MD
Phone: 618-526-8850