Port Orange Pediatrics P a

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

ME0068668 Issued in FL

Legal business name

PORT ORANGE PEDIATRICS P A

Practice address

1720 Dunlawton Ave
Suite 1
Port Orange, FL 32127-2915

Phone

(386) 322-5390

NPI assigned

Jan 31, 2008

Organization subpart

No

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

Authorized official

Name

Ruben J Lopez, MDNPI 1396704821

Title

President

Phone

(386) 322-5390

Specialties & licenses 1

Addresses

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/12004/brand/1/csg/1/fhir/r4

Practitioners 2

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

• Ruben J Lopez, MD

  • Pediatrics Physician
  • Port Orange, FL
  • NPI 1396704821
  NPD Authorized official
• Guillermina Gonzalez-Lopez, APRN

  • Nurse Practitioner
  • Gainesville, FL
  • NPI 1346058369
  NPD

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

{
    "created_epoch": "1201737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643155200000",
    "number": "1902084064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1728 DUNLAWTON AVE STE 1",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321272923",
            "telephone_number": "386-322-5390",
            "fax_number": "386-322-5391"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1720 DUNLAWTON AVE",
            "address_2": "SUITE 1",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321272915",
            "telephone_number": "386-322-5390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORT ORANGE PEDIATRICS P A",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-31",
        "last_updated": "2022-01-26",
        "certification_date": "2022-01-26",
        "status": "A",
        "authorized_official_last_name": "LOPEZ",
        "authorized_official_first_name": "RUBEN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "386-322-5390",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME0068668",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Port Orange Chiropractic Inc
• Port Orange Endoscopy & Surgery Center LLC
• Port Orange Gynecology LLC
• Port Orange Internists PA
• Port Orange Modern Dentistry, PA
• Port Orange Physical Therapy Limited Partnership
• Bree Porter
• Dorothy Whatley Porter, PA
• Ann Potopowicz
• Cherokee Young Potter

• Pediatrics Physician in Port Orange, FL
• Providers in Port Orange, FL by specialty
• Pediatrics Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2022; 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.