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General NPI Number Information
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NPI Number | 1457691347
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Entity Type | Organization
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Legal Business Name | LITTLE HOUSE PEDIATRICS L.L.C.
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Dates
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Enumeration Date | 03/01/2013
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Last Update Date | 10/14/2013
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Provider Practice Location Address
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Address Line | 8734 LEE VISTA BLVD SUITE 400
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City | ORLANDO
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State | FL
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Zip | 32829-8022
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Country | US
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Telephone | 407-910-2340
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Fax |
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Provider Business Mailing Address
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Address Line | 8734 LEE VISTA BLVD SUITE 400
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City | ORLANDO
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State | FL
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Zip | 32829-8022
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Country | US
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Telephone | 407-910-2340
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Fax |
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Authorized Official
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Title or Position | MANAGAMENT MEMBER
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Name | DR. SANTIAGO A. JIMENEZ
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Credential | M.D.
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Telephone | 407-910-2340
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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 | ME65074
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License Number State | FL
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