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General NPI Number Information
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NPI Number | 1881093276
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Entity Type | Organization
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Legal Business Name | PEDIATRIC PRIME CARE
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Dates
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Enumeration Date | 08/21/2014
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Last Update Date | 08/21/2014
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Provider Practice Location Address
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Address Line | 1801 SE HILLMOOR DRIVE SUITE A105
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34952-7545
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Country | US
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Telephone | 772-335-9949
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Fax | 772-335-9719
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Provider Business Mailing Address
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Address Line | 1801 SE HILLMOOR DRIVE SUITE A105
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34952-7545
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Country | US
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Telephone | 772-335-9949
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Fax | 772-335-9719
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Authorized Official
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Title or Position | CEO
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Name | DR. PRITHVI RAJ SAWH
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Credential | M.D.
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Telephone | 772-335-9949
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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 | 66915
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License Number State | FL
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