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General NPI Number Information
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NPI Number | 1508955212
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Entity Type | Organization
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Legal Business Name | KIDSVILLE PEDIATRICS IV, P.A.
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 08/13/2019
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Provider Practice Location Address
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Address Line | 11886 LAKE UNDERHILL RD
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City | ORLANDO
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State | FL
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Zip | 32825-4436
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Country | US
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Telephone | 407-447-7773
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Fax | 407-447-7804
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Provider Business Mailing Address
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Address Line | 11886 LAKE UNDERHILL RD
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City | ORLANDO
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State | FL
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Zip | 32825-4436
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Country | US
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Telephone | 407-447-7773
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Fax | 407-447-7804
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Authorized Official
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Title or Position | CEO
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Name | DR. FRANCELIS I. GONZALEZ
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Credential | MEDICAL DOCTOR
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Telephone | 407-447-7773
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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-0074421
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License Number State | FL
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