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General NPI Number Information
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NPI Number | 1881022010
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Entity Type | Organization
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Legal Business Name | KIDDIE CARDIOLOGY LLC
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Dates
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Enumeration Date | 10/25/2013
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Last Update Date | 10/24/2017
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Provider Practice Location Address
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Address Line | 512 W CHERRY ST STE D
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City | KISSIMMEE
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State | FL
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Zip | 34741-4114
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Country | US
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Telephone | 407-530-4928
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Fax | 407-530-4794
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Provider Business Mailing Address
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Address Line | PO BOX 1286
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City | WINDERMERE
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State | FL
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Zip | 34786-1286
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Country | US
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Telephone | 800-454-9454
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Fax | 800-454-9655
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Authorized Official
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Title or Position | MANAGER
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Name | YAMIRAH IGLESIAS
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Credential |
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Telephone | 407-530-4928
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number |
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License Number State |
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