MEDICARE: SANTA ROSA PEDIATRICS OF FLORIDA P.A.

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	ME90770	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	IND NPI	OTHER		DR. LUIS A GHIGLINO

General Provider Information

NPI Number	:	1922095512
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANTA ROSA PEDIATRICS OF FLORIDA P.A.

Provider Business Mailing Address
First Line	:	5962 BERRYHILL RD
Second Line	:
City	:	MILTON
State	:	FL
Zip	:	32570-4009
Country	:	US
Telephone Number	:	850-983-3700
Fax Number	:	850-983-0970

Provider Business Practice Location Address
First Line	:	5962 BERRYHILL RD
Second Line	:
City	:	MILTON
State	:	FL
Zip	:	32570-4009
Country	:	US
Telephone Number	:	850-983-3700
Fax Number	:	850-983-0970

Authorized Official
Title or Position	:	OWNER
Name	:	DR. LUIS A GHIGLINO
Credential	:	MD
Telephone Number	:	850-983-3700

Provider Enumeration Date	:	09/29/2005
Last Update Date	:	08/22/2020

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