=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922761097
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRUCARE PEDIATRICS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/15/2021
-----------------------------------------------------
Last Update Date | 11/15/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5200 BABCOCK ST NE STE 302
-----------------------------------------------------
City | PALM BAY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32905-4648
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-285-7212
-----------------------------------------------------
Fax | 321-250-2038
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5200 BABCOCK ST NE STE 302
-----------------------------------------------------
City | PALM BAY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32905-4648
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-285-7212
-----------------------------------------------------
Fax | 321-250-2038
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | DR. ERIKA DIOGENE
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 321-285-7212
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------