MEDICARE: PEDIATRIC HEALTH CARE ALLIANCE, PA

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	ME70581	FL

General Provider Information

NPI Number	:	1730486762
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRIC HEALTH CARE ALLIANCE, PA

Provider Business Mailing Address
First Line	:	720 BROOKER CREEK BLVD STE 215
Second Line	:
City	:	OLDSMAR
State	:	FL
Zip	:	34677-2937
Country	:	US
Telephone Number	:	813-854-2003
Fax Number	:	813-436-5378

Provider Business Practice Location Address
First Line	:	5621 SKYTOP DR
Second Line	:
City	:	LITHIA
State	:	FL
Zip	:	33547-4165
Country	:	US
Telephone Number	:	813-571-6800
Fax Number	:	813-654-9939

Authorized Official
Title or Position	:	COO
Name	:	DEBRA S GONZALEZ
Credential	:
Telephone Number	:	813-854-2003

Provider Enumeration Date	:	02/28/2011
Last Update Date	:	08/10/2022

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