Kidsville Pediatrics III, P.a.

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

KIDSVILLE PEDIATRICS III, P.A.

Practice address

1804 Oakley Seaver Blvd
Suite-C
Clermont, FL 34711-1925

Phone

(352) 242-1021

Fax

(352) 242-1104

NPI assigned

Feb 14, 2006

Organization subpart

No

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

(352) 242-1021

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jean Carlos Martinez Cruz, M.D.

  • General Practice Physician
  • Saint Cloud, FL
  • NPI 1497100952
  Medicare reassignment
• Raymond Rodriguez Negron, M.D.

  • General Practice Physician
  • Kissimmee, FL
  • NPI 1154874584
  Medicare reassignment
• Francelis Ivette Gonzalez, MD

  • Pediatrics Physician
  • Kissimmee, FL
  • NPI 1972580322
  NPD
• Carlos Alexis Estrella Gonzalez, M.D.

  • Pediatrics Physician
  • Clermont, FL
  • NPI 1073843991

  Single Specialty

  NPD (past)

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

{
    "created_epoch": "1139875200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737504000000",
    "number": "1215901723",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1804 OAKLEY SEAVER BLVD",
            "address_2": "SUITE-C",
            "city": "CLERMONT",
            "state": "FL",
            "postal_code": "347111925",
            "telephone_number": "352-242-1021",
            "fax_number": "352-242-1104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1804 OAKLEY SEAVER BLVD",
            "address_2": "SUITE-C",
            "city": "CLERMONT",
            "state": "FL",
            "postal_code": "347111925",
            "telephone_number": "352-242-1021",
            "fax_number": "352-242-1104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDSVILLE PEDIATRICS III, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-14",
        "last_updated": "2025-01-22",
        "certification_date": "2025-01-22",
        "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": "352-242-1021",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001599400",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "125226800",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "FL206A",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rafeena Wahab Khan
• Rizwan Khan, D.O
• Arthur Kharonov
• Kidney & Hypertension Specialists of Central Florida
• Kids Therapy Tower
• Ciara Brooke Hampton Kidwell
• Owen Robert Kieran, D.O.
• Paul Kim, MD
• Kinder Konsulting & Parents Too, Inc.
• Kinder Konsulting & Parents Too, Inc.

• General Practice Physician in Clermont, FL
• Providers in Clermont, FL by specialty
• General Practice Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.