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General NPI Number Information
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NPI Number | 1316933799
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Entity Type | Organization
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Legal Business Name | CENTRAL FLORIDA PEDIATRIC INTENSVIE CARE SPECIALIST
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Dates
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Enumeration Date | 09/21/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 844 N THORNTON AVE
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City | ORLANDO
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State | FL
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Zip | 32803-4003
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Country | US
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Telephone | 407-894-8768
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Fax |
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Provider Business Mailing Address
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Address Line | 844 N THORNTON AVE
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City | ORLANDO
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State | FL
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Zip | 32803-4003
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Country | US
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Telephone | 407-894-8768
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. AYODEJI V OTEGBEYE
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Credential | MD
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Telephone | 407-894-8768
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0203X
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Taxonomy Name | Pediatric Critical Care Medicine Physician
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License Number | ME58278
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License Number State | FL
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