NPIMap

Organization Active NPI

Childrens Clinic of Pensacola PA

  • Pediatrics Physician
  • Pensacola, FL
National Provider Identifier
1023256476
Registry record updated Jan 22, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
ME89920 Issued in FL
Legal business name
CHILDRENS CLINIC OF PENSACOLA PA
Practice address
4220 N Davis Hwy Ste 200
Pensacola, FL 32503-2721
Phone
(850) 477-5475
Fax
(850) 477-8186
NPI assigned
Jan 22, 2009
Last updated
Jan 22, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Mylene M Victoriano, M.D.NPI 1417991043
Title
President
Phone
(850) 477-5475

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X ME89920 FL Primary
Pediatrics Physician 208000000X ME87962 FL

Addresses

Primary practice location

4220 N Davis Hwy Ste 200
Pensacola, FL 32503-2721

Mailing address

4220 N Davis Hwy Ste 200
Pensacola, FL 32503-2721
Phone (850) 477-5475

National Provider Directory

National Provider Directory

Locations

4220 N Davis Hwy
Ste 200
Pensacola, FL 32503
Phone (850) 477-5475

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1232582400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1232582400000",
    "number": "1023256476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4220 N DAVIS HWY STE 200",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325032721",
            "telephone_number": "850-477-5475",
            "fax_number": "850-477-8186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4220 N DAVIS HWY STE 200",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325032721",
            "telephone_number": "850-477-5475",
            "fax_number": "850-477-8186"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILDRENS CLINIC OF PENSACOLA PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-22",
        "last_updated": "2009-01-22",
        "status": "A",
        "authorized_official_last_name": "VICTORIANO",
        "authorized_official_first_name": "MYLENE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "850-477-5475",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME89920",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME87962",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pensacola, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.