MEDICARE: URQUIZA PEDIATRICS

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	ME14800	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
2	ME-14800	OTHER		STATE LICENSE
3	D56485	OTHER	FL	UPIN

General Provider Information

NPI Number	:	1134446107
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	URQUIZA PEDIATRICS

Provider Business Mailing Address
First Line	:	1545 LAKELAND HILLS BLVD
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33805-3246
Country	:	US
Telephone Number	:	863-686-5943
Fax Number	:	863-686-4013

Provider Business Practice Location Address
First Line	:	1545 LAKELAND HILLS BLVD
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33805-3246
Country	:	US
Telephone Number	:	863-686-5943
Fax Number	:	863-686-4013

Authorized Official
Title or Position	:	BILLING AGENT
Name	:	NIKKI MORRIS
Credential	:
Telephone Number	:	863-534-3259

Provider Enumeration Date	:	04/29/2010
Last Update Date	:	04/29/2010

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Directions to “URQUIZA PEDIATRICS ” Practice Location

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