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General NPI Number Information
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NPI Number | 1063568855
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Entity Type | Organization
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Legal Business Name | HUNTCLUB PEDIATRIC ASSOCIATES, LLC
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 03/22/2016
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Provider Practice Location Address
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Address Line | 425 S HUNT CLUB BLVD STE 1051
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City | APOPKA
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State | FL
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Zip | 32703
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Country | US
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Telephone | 407-786-4080
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Fax | 407-786-4667
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Provider Business Mailing Address
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Address Line | 425 S HUNT CLUB BLVD STE 1051
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City | APOPKA
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State | FL
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Zip | 32703
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Country | US
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Telephone | 407-786-4080
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CARLOS CHABAN
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Credential | MD
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Telephone | 407-786-4080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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