Pediatrice Center for Developmental Excellence, LLC

Primary specialty

Developmental - Behavioral Pediatrics PhysicianTaxonomy code 2080P0006X

License

1229 Issued in VI

Legal business name

PEDIATRICE CENTER FOR DEVELOPMENTAL EXCELLENCE, LLC

Practice address

79 Estate Peter'S Rest
Suite 3.2
Christiansted, VI 00820

Phone

(340) 473-7225

NPI assigned

Sep 1, 2016

Organization subpart

No

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

Authorized official

Name

Trevena Moore, MD

Title

Member

Phone

(617) 306-2065

Specialties & licenses 2

Addresses

Other names 1

• Pediatric Building Blocks Doing business as

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

{
    "created_epoch": "1472688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1473638400000",
    "number": "1629524327",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 159",
            "city": "CHRISTIANSTED",
            "state": "VI",
            "postal_code": "008210159",
            "telephone_number": "340-473-7225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "79 ESTATE PETER'S REST",
            "address_2": "SUITE 3.2",
            "city": "CHRISTIANSTED",
            "state": "VI",
            "postal_code": "00820",
            "telephone_number": "340-473-7225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRICE CENTER FOR DEVELOPMENTAL EXCELLENCE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-01",
        "last_updated": "2016-09-12",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "TREVENA",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "617-306-2065",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "VI",
            "license": "2351041B",
            "primary": false
        },
        {
            "code": "2080P0006X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Developmental - Behavioral Pediatrics",
            "state": "VI",
            "license": "1229",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pediatric Building Blocks",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jong Hwa Park, MD
• Sophia Joseph Parrilla, PHD, CLINICAL PSYCH
• Camille Marise Paul, PA-C
• McKenna Peck
• Pediatric Care Center LLC
• John Charles Perez, MD
• Cleopatra Peter, DC
• Dominique Petersen
• James Phipps
• Physical Therapy Center of St. Croix, LLC

• All providers in Christiansted, VI
• Developmental - Behavioral Pediatrics Physician in U.S. Virgin Islands

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2016; 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.