Provider Demographics
NPI:1386994952
Name:PEDIATRIC CARE CENTER NO2 INC
Entity type:Organization
Organization Name:PEDIATRIC CARE CENTER NO2 INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/AO
Authorized Official - Prefix:MR
Authorized Official - First Name:ARMANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-641-0811
Mailing Address - Street 1:2135 S CONGRESS AVE STE 2B
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33406-7611
Mailing Address - Country:US
Mailing Address - Phone:561-641-0811
Mailing Address - Fax:561-641-0813
Practice Address - Street 1:2135 S CONGRESS AVE STE 2B
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33406-7611
Practice Address - Country:US
Practice Address - Phone:561-641-0811
Practice Address - Fax:561-641-0813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-11
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208000000X
FLME688588261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003999000Medicaid
FL251597100Medicaid
FL114285600Medicaid