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General NPI Number Information
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NPI Number | 1063948560
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Entity Type | Organization
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Legal Business Name | INSTITUTE OF PEDIATRIC NEUROSCIENCES
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Dates
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Enumeration Date | 05/04/2017
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Last Update Date | 05/04/2017
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Provider Practice Location Address
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Address Line | 1315 SE 25TH LOOP UNIT 104
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City | OCALA
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State | FL
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Zip | 34471-1030
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Country | US
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Telephone | 352-260-7343
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Fax |
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Provider Business Mailing Address
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Address Line | 1315 SE 25TH LOOP UNIT 104
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City | OCALA
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State | FL
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Zip | 34471-1030
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Country | US
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Telephone | 352-260-7343
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | EDGARD O ANDRADE
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Credential | MD
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Telephone | 352-260-7346
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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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