NPIMap

Organization Active NPI

St. John's Pediatrics, P.a.

  • Pediatrics Physician
  • St Augustine, FL
National Provider Identifier
1386843506
Registry record updated Jul 17, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
ME90096 Issued in FL
Legal business name
ST. JOHN'S PEDIATRICS, P.A.
Practice address
161 Hampton Point Dr
Suite 4
Saint Augustine, FL 32092-3057
Phone
(904) 230-0624
Fax
(904) 230-7947
NPI assigned
Jul 17, 2007
Organization subpart
Yes
Parent organization
ST. JOHN'S PEDIATRICS, P.A. MAIN OFFICEAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 17, 2007

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

Authorized official

Name
Dr. Leticia Rosario Abrea, M.D.
Title
President
Phone
(904) 230-0624

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X ME90096 FL Primary

Addresses

Primary practice location

161 Hampton Point Dr
Suite 4
Saint Augustine, FL 32092-3057

Mailing address

161 Hampton Point Dr
Suite 4
Saint Augustine, FL 32092-3057
Phone (904) 230-0624

National Provider Directory

National Provider Directory
Tax ID family
St John's Pediatrics PA2 organizations share this tax ID, including this one
Part of
St John's Pediatrics PA

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1184630400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184630400000",
    "number": "1386843506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "161 HAMPTON POINT DR",
            "address_2": "SUITE 4",
            "city": "SAINT AUGUSTINE",
            "state": "FL",
            "postal_code": "320923057",
            "telephone_number": "904-230-0624",
            "fax_number": "904-230-7947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "161 HAMPTON POINT DR",
            "address_2": "SUITE 4",
            "city": "SAINT AUGUSTINE",
            "state": "FL",
            "postal_code": "320923057",
            "telephone_number": "904-230-0624",
            "fax_number": "904-230-7947"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. JOHN'S PEDIATRICS, P.A.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST. JOHN'S PEDIATRICS, P.A. MAIN OFFICE",
        "enumeration_date": "2007-07-17",
        "last_updated": "2007-07-17",
        "status": "A",
        "authorized_official_last_name": "ABREA",
        "authorized_official_first_name": "LETICIA",
        "authorized_official_middle_name": "ROSARIO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "904-230-0624",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME90096",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Augustine, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2007; 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.