Provider Demographics
NPI:1154402857
Name:PEDSCARE PA
Entity type:Organization
Organization Name:PEDSCARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:CRISTINA
Authorized Official - Last Name:SOTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD FAAP
Authorized Official - Phone:352-742-2585
Mailing Address - Street 1:1801 SALK AVE
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-4311
Mailing Address - Country:US
Mailing Address - Phone:352-742-2585
Mailing Address - Fax:352-742-0724
Practice Address - Street 1:1801 SALK AVE
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-4311
Practice Address - Country:US
Practice Address - Phone:352-742-2585
Practice Address - Fax:352-742-0724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME75364208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL43563OtherBCBS OF FL
FL43563OtherBCBS OF FL