Provider Demographics
NPI:1285070193
Name:PEDIATRICS OF GREATER ORLANDO
Entity type:Organization
Organization Name:PEDIATRICS OF GREATER ORLANDO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HERNANDO
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:CARDONA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-716-4592
Mailing Address - Street 1:1803 WESTOVER RESERVE BLVD
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-6213
Mailing Address - Country:US
Mailing Address - Phone:407-716-4592
Mailing Address - Fax:
Practice Address - Street 1:1515 PARK CENTER DR
Practice Address - Street 2:SUITE D
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-5794
Practice Address - Country:US
Practice Address - Phone:407-716-4592
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-18
Last Update Date:2013-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88235261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care