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General NPI Number Information
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NPI Number | 1184504102
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Entity Type | Organization
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Legal Business Name | 407 PEDIATRICS LLC
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Dates
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Enumeration Date | 09/03/2025
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Last Update Date | 09/03/2025
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Provider Practice Location Address
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Address Line | 161 WEBB DR STE 300
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City | DAVENPORT
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State | FL
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Zip | 33837-3965
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Country | US
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Telephone | 407-873-5979
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Fax |
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Provider Business Mailing Address
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Address Line | 161 WEBB DR STE 300
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City | DAVENPORT
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State | FL
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Zip | 33837-3965
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Country | US
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Telephone | 407-873-5979
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Fax |
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Authorized Official
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Title or Position | REGISTERED AGENT/OWNER
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Name | DANIELLE HERNANDEZ
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Credential | MD
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Telephone | 407-873-5979
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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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