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General NPI Number Information
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NPI Number | 1457761603
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Entity Type | Organization
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Legal Business Name | DUNEDIN PEDIATRICS LLC
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Dates
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Enumeration Date | 04/28/2014
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Last Update Date | 02/11/2021
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Provider Practice Location Address
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Address Line | 424 DOUGLAS AVE
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City | DUNEDIN
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State | FL
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Zip | 34698-7602
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Country | US
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Telephone | 210-913-4881
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Fax |
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Provider Business Mailing Address
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Address Line | 424 DOUGLAS AVE
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City | DUNEDIN
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State | FL
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Zip | 34698-7602
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Country | US
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Telephone | 727-734-7337
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Fax | 727-216-3883
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | VIVIAN MARIE HERRERO
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Credential | MD
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Telephone | 727-734-7337
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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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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