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General NPI Number Information
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NPI Number | 1194033753
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Entity Type | Organization
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Legal Business Name | PINNACLES PEDS CARE, PA
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Dates
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Enumeration Date | 09/16/2010
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Last Update Date | 09/16/2010
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Provider Practice Location Address
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Address Line | 180 PINNACLES DR SUITE 100
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City | PALM COAST
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State | FL
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Zip | 32164-2596
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Country | US
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Telephone | 386-313-1963
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Fax |
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Provider Business Mailing Address
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Address Line | 3 COLLEGE CT
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City | PALM COAST
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State | FL
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Zip | 32137-9034
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. VINCENT G VERDEFLOR
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Credential | M.D.
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Telephone | 386-597-2298
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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 | ME 97678
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License Number State | FL
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