Provider Demographics
NPI:1215063821
Name:PEDIATRIC HEALTH CARE
Entity type:Organization
Organization Name:PEDIATRIC HEALTH CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RAZA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-563-2821
Mailing Address - Street 1:5308 S JOHN YOUNG PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32839-7362
Mailing Address - Country:US
Mailing Address - Phone:407-563-2821
Mailing Address - Fax:407-240-9508
Practice Address - Street 1:5308 S JOHN YOUNG PKWY
Practice Address - Street 2:STE. 200
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32839-7362
Practice Address - Country:US
Practice Address - Phone:407-563-2821
Practice Address - Fax:407-240-9508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 62109208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty