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General NPI Number Information
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NPI Number | 1558648451
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Entity Type | Organization
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Legal Business Name | MY TAMPA BAY PEDIATRICS, P.A.
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Dates
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Enumeration Date | 11/07/2011
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Last Update Date | 11/07/2011
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Provider Practice Location Address
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Address Line | 26907 FOGGY CREEK RD STE 102
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City | WESLEY CHAPEL
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State | FL
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Zip | 33544-6778
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Country | US
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Telephone | 813-991-7337
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Fax | 813-994-0806
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Provider Business Mailing Address
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Address Line | PO BOX 89038
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City | TAMPA
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State | FL
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Zip | 33689-0400
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Country | US
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Telephone | 813-418-5246
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Fax | 813-994-0806
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CARMEN C ALFARO
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Credential | MD
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Telephone | 813-991-7337
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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 | ME92726
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License Number State | FL
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