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General NPI Number Information
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NPI Number | 1578908968
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Entity Type | Organization
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Legal Business Name | BIGBEND PEDIATRIC CARE, LLC
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Dates
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Enumeration Date | 04/30/2013
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Last Update Date | 09/13/2022
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Provider Practice Location Address
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Address Line | 13131 KINGS LAKE DR SUITE 101
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City | GIBSONTON
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State | FL
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Zip | 33534-3959
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Country | US
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Telephone | 813-672-6092
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Fax | 813-677-1892
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Provider Business Mailing Address
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Address Line | 13131 KINGS LAKE DR SUITE 101
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City | GIBSONTON
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State | FL
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Zip | 33534-3959
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Country | US
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Telephone | 813-672-6092
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Fax | 813-677-1892
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Authorized Official
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Title or Position | OWNER
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Name | ROLANDO GARCIA
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Credential |
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Telephone | 813-672-6092
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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 |
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License Number State |
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