NPIMap

Organization Active NPI

Kidsville Pediatrics II, P.a.

  • Pediatrics Physician
  • Kissimmee, FL
National Provider Identifier
1144292756
Registry record updated Aug 13, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
ME-0074421 Issued in FL
Legal business name
KIDSVILLE PEDIATRICS II, P.A.
Practice address
1050 W Carroll St
Kissimmee, FL 34741-1268
Phone
(407) 518-0078
Fax
(407) 518-0094
NPI assigned
Feb 7, 2006
Last updated
Aug 13, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2019

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

Authorized official

Name
Mr. Victor M. Pantoja Jr.
Title
Administrator
Phone
(407) 518-0078

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X ME-0074421 FL Primary

Addresses

Primary practice location

1050 W Carroll St
Kissimmee, FL 34741-1268

Mailing address

1050 W Carroll St
Kissimmee, FL 34741-1268
Phone (407) 518-0078

Other practice location 1

1050 W Carroll St
Kissimmee, FL 34741-1268
Phone (407) 518-0078

Other practice location 2

1050 W Carroll St
Kissimmee, FL 34741-1268
Phone (407) 518-0078

Other identifiers 1

IdentifierTypeStateIssuer
274049400MedicaidFL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D1007087Kidsville Pediatrics II PA1050 W Carroll St, Kissimmee, FL 34741Certificate of waiverDec 8, 2026

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1139270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1565654400000",
    "number": "1144292756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1050 W CARROLL ST",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347411268",
            "telephone_number": "407-518-0078",
            "fax_number": "407-518-0094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1050 W CARROLL ST",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347411268",
            "telephone_number": "407-518-0078",
            "fax_number": "407-518-0094"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1050 W Carroll St",
            "address_purpose": "LOCATION",
            "city": "Kissimmee",
            "state": "FL",
            "postal_code": "347411268",
            "country_code": "US",
            "telephone_number": "407-518-0078",
            "fax_number": "407-518-0094",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1050 W Carroll St",
            "address_purpose": "LOCATION",
            "city": "Kissimmee",
            "state": "FL",
            "postal_code": "347411268",
            "country_code": "US",
            "telephone_number": "407-518-0078",
            "fax_number": "407-518-0094",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "KIDSVILLE PEDIATRICS II, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-07",
        "last_updated": "2019-08-13",
        "status": "A",
        "authorized_official_last_name": "PANTOJA JR.",
        "authorized_official_first_name": "VICTOR",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "407-518-0078",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME-0074421",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "274049400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kissimmee, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.