=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023489630
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BEE WELL PEDIATRICS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/08/2015
-----------------------------------------------------
Last Update Date | 12/10/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10521 SW VILLAGE CENTER DR 101-A
-----------------------------------------------------
City | PORT ST LUCIE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34987-1930
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-873-7114
-----------------------------------------------------
Fax | 772-873-7115
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 880313
-----------------------------------------------------
City | PORT ST LUCIE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34988-0313
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-873-7114
-----------------------------------------------------
Fax | 772-873-7115
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. VERONICA D ESPINOZA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 772-236-9860
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | ME93497
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------