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General NPI Number Information
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NPI Number | 1780658294
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Entity Type | Organization
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Legal Business Name | KIDSVILLE PEDIATRICS I, P.A.
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Dates
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Enumeration Date | 02/14/2006
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Last Update Date | 01/22/2025
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Provider Practice Location Address
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Address Line | 2201 NORTH BLVD W
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City | DAVENPORT
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State | FL
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Zip | 33837-8990
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Country | US
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Telephone | 863-419-0688
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Fax | 863-419-9547
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Provider Business Mailing Address
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Address Line | 2201 NORTH BLVD W
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City | DAVENPORT
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State | FL
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Zip | 33837-8990
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Country | US
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Telephone | 863-419-0688
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Fax | 863-419-9547
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. VICTOR M. PANTOJA JR.
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Credential |
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Telephone | 863-419-0688
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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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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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