=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821325390
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PEDI-MEDICAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/04/2009
-----------------------------------------------------
Last Update Date | 11/04/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1776 SUN RIDGE DR
-----------------------------------------------------
City | APOPKA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32703-8259
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-722-1652
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 770485
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32877-0485
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-722-1652
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. DAVID ALFREDO AFANADOR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 407-722-1652
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------