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General NPI Number Information
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NPI Number | 1396822862
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Entity Type | Organization
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Legal Business Name | SAINT LUCIE PEDIATRICS INC
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | 2011 S 25TH ST STE 105
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City | FORT PIERCE
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State | FL
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Zip | 34947-4795
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Country | US
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Telephone | 772-460-8235
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Fax |
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Provider Business Mailing Address
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Address Line | 2011 S 25TH ST STE 105
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City | FORT PIERCE
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State | FL
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Zip | 34947-4795
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Country | US
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Telephone | 772-460-8235
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. RAUL RODRIGUEZ-TORRES
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Credential | M.D.
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Telephone | 772-460-8235
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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 | ME54098
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License Number State | FL
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