Kidsville Pediatrics I, P.a.

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

KIDSVILLE PEDIATRICS I, P.A.

Practice address

2201 North Blvd W
Davenport, FL 33837-8990

Phone

(863) 419-0688

Fax

(863) 419-9547

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

(863) 419-0688

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

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 NPD
• Raymond Rodriguez Negron, M.D.

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

  • Pediatrics Physician
  • Kissimmee, FL
  • NPI 1972580322
  NPD
• Pedro Vazquez, M.D.

  • Pediatrics Physician
  • Kissimmee, FL
  • NPI 1528043981
  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": "1780658294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2201 NORTH BLVD W",
            "city": "DAVENPORT",
            "state": "FL",
            "postal_code": "338378990",
            "telephone_number": "863-419-0688",
            "fax_number": "863-419-9547"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2201 NORTH BLVD W",
            "city": "DAVENPORT",
            "state": "FL",
            "postal_code": "338378990",
            "telephone_number": "863-419-0688",
            "fax_number": "863-419-9547"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDSVILLE PEDIATRICS I, 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": "863-419-0688",
        "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": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "GV270A",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "265713900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Maria Cristina Khan, M.D.
• Ruba Khandakji
• Sehrish Khurram
• Mahdieh Kiany, DMD
• Kids R Our Future Corp.
• Kidsville Pediatrics VII, P.a. After Hours Walk-in Clinic
• Ahjin Kim
• Debra Anne King-Ferro, PHD
• Lisa King, LMHC
• Kelly Kingsbury

• General Practice Physician in Davenport, FL
• Providers in Davenport, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.