MEDICARE: MY CHILDREN'S DOCTOR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	ME62983	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083622633
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MY CHILDREN'S DOCTOR

Provider Business Mailing Address
First Line	:	2484 CARING WAY
Second Line	:	SUITE D
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-5306
Country	:	US
Telephone Number	:	941-625-1999
Fax Number	:	941-625-4600

Provider Business Practice Location Address
First Line	:	2484 CARING WAY
Second Line	:	SUITE D
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-6729
Country	:	US
Telephone Number	:	941-625-1999
Fax Number	:	941-625-4600

Authorized Official
Title or Position	:	CEO
Name	:	DR. LUIS R RODRIGUEZ
Credential	:	M.D.
Telephone Number	:	941-625-1999

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	09/30/2011

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Directions to “MY CHILDREN'S DOCTOR ” Practice Location

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