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General NPI Number Information
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NPI Number | 1609151315
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Entity Type | Organization
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Legal Business Name | KIDS DOC PEDIATRICS
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Dates
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Enumeration Date | 10/13/2011
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Last Update Date | 10/13/2011
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Provider Practice Location Address
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Address Line | 6440 W NEWBERRY RD SUITE 105
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City | GAINESVILLE
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State | FL
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Zip | 32605-4381
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Country | US
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Telephone | 352-332-4400
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Fax |
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Provider Business Mailing Address
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Address Line | 6440 W NEWBERRY RD SUITE 105
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City | GAINESVILLE
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State | FL
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Zip | 32605-4381
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Country | US
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Telephone | 352-332-4400
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. LUIS E SCACCABARROZZI
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Credential | MD
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Telephone | 352-332-4400
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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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