MEDICARE: SAINT LUCIE PEDIATRICS INC

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	ME54098	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	:	1396822862
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAINT LUCIE PEDIATRICS INC

Provider Business Mailing Address
First Line	:	2011 S 25TH ST STE 105
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34947-4795
Country	:	US
Telephone Number	:	772-460-8235
Fax Number	:

Provider Business Practice Location Address
First Line	:	2011 S 25TH ST STE 105
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34947-4795
Country	:	US
Telephone Number	:	772-460-8235
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. RAUL RODRIGUEZ-TORRES
Credential	:	M.D.
Telephone Number	:	772-460-8235

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	06/18/2008

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Directions to “SAINT LUCIE PEDIATRICS INC ” Practice Location

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