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General NPI Number Information
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NPI Number | 1023190915
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Entity Type | Organization
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Legal Business Name | WAKEFIELD PEDIATRICS & ADOLESCENT MEDICINE,P.A.
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Dates
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Enumeration Date | 10/19/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 14341 NEW FALLS OF NEUSE SUITE 122
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City | RALEIGH
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State | NC
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Zip | 27614-8292
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Country | US
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Telephone | 919-570-7010
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Fax | 919-570-7020
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Provider Business Mailing Address
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Address Line | 14341 NEW FALLS OF NEUSE SUITE 122
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City | RALEIGH
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State | NC
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Zip | 27614-8292
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Country | US
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Telephone | 919-570-7010
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Fax | 919-570-7020
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MILTON-JESUS CABALONA SEVILLA
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Credential | M.D.
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Telephone | 919-570-7010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State | NC
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