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General NPI Number Information
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NPI Number | 1710235569
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Entity Type | Organization
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Legal Business Name | WEST COAST PEDIATRICS
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Dates
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Enumeration Date | 08/28/2012
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Last Update Date | 02/07/2024
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Provider Practice Location Address
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Address Line | 1414 59TH STREET WEST
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City | BRADENTON
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State | FL
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Zip | 34209-4607
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Country | US
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Telephone | 941-761-0663
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Fax | 941-761-3347
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Provider Business Mailing Address
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Address Line | 1414 59TH STREET WEST
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City | BRADENTON
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State | FL
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Zip | 34209-4607
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Country | US
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Telephone | 941-761-0663
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Fax | 941-761-3347
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Authorized Official
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Title or Position | PHYSICIAN
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Name | CONSTANCE CHARLES-LOGAN
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Credential | M.D.
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Telephone | 941-761-0663
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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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