Organization Active NPI

My Children'S Doctor

  • Pediatrics Physician
  • Port Charlotte, FL
National Provider Identifier
1083622633
Registry record updated Sep 30, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
ME62983 Issued in FL
Legal business name
MY CHILDREN'S DOCTOR
Practice address
2484 Caring Way
Suite D
Port Charlotte, FL 33952-6729
Phone
(941) 625-1999
Fax
(941) 625-4600
NPI assigned
Aug 3, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2011

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

Authorized official

Name
Dr. Luis R Rodriguez, M.D.
Title
Ceo
Phone
(941) 625-1999

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X ME62983 FL Primary

Addresses

Primary practice location

2484 Caring Way
Suite D
Port Charlotte, FL 33952-6729

Mailing address

2484 Caring Way
Suite D
Port Charlotte, FL 33952-5306
Phone (941) 625-1999

Other identifiers 1

IdentifierTypeStateIssuer
269202300MedicaidFL

National Provider Directory

National Provider Directory

Locations

2484 Caring Way
Unit D
Pt Charlotte, FL 33952
Phone (941) 205-2666

NPI Registry JSON

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

{
    "created_epoch": "1154563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1317340800000",
    "number": "1083622633",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2484 CARING WAY",
            "address_2": "SUITE D",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339525306",
            "telephone_number": "941-625-1999",
            "fax_number": "941-625-4600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2484 CARING WAY",
            "address_2": "SUITE D",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339526729",
            "telephone_number": "941-625-1999",
            "fax_number": "941-625-4600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MY CHILDREN'S DOCTOR",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-03",
        "last_updated": "2011-09-30",
        "status": "A",
        "authorized_official_last_name": "RODRIGUEZ",
        "authorized_official_first_name": "LUIS",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "941-625-1999",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME62983",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "269202300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Charlotte, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2011; 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.