Kidsville Pediatrics VI, PA After Hours Clinic

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

KIDSVILLE PEDIATRICS VI, PA AFTER HOURS CLINIC

Practice address

11886 Lake Underhill Rd
Orlando, FL 32825-4436

Phone

(407) 447-7773

Fax

(407) 447-7804

NPI assigned

Jun 9, 2011

Last updated

Aug 13, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Victor Manuel Pantoja Jr.

Title

Cfo/Administrator

Phone

(407) 447-7773

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1307577600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1565654400000",
    "number": "1750676581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11886 LAKE UNDERHILL RD",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328254436",
            "telephone_number": "407-447-7773",
            "fax_number": "407-447-7804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11886 LAKE UNDERHILL RD",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328254436",
            "telephone_number": "407-447-7773",
            "fax_number": "407-447-7804"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11886 Lake Underhill Rd",
            "address_purpose": "LOCATION",
            "city": "Orlando",
            "state": "FL",
            "postal_code": "328254436",
            "country_code": "US",
            "telephone_number": "407-447-7773",
            "fax_number": "407-447-7804",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "KIDSVILLE PEDIATRICS VI, PA AFTER HOURS CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-09",
        "last_updated": "2019-08-13",
        "status": "A",
        "authorized_official_last_name": "PANTOJA",
        "authorized_official_first_name": "VICTOR",
        "authorized_official_middle_name": "MANUEL",
        "authorized_official_title_or_position": "CFO/ADMINISTRATOR",
        "authorized_official_telephone_number": "407-447-7773",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.