Port Orange Pediatrics P a

NPI #1902084064 in Port Orange, Florida

Provider Information

NPI Number: 1902084064
Entity Type: Organization
Organization Name: Port Orange Pediatrics P a
Primary Specialty: Pediatrics
Enumeration Date: Jan 31, 2008
Last Updated: Jan 26, 2022

Practice Location

Address: 1720 DUNLAWTON AVE
Address 2: SUITE 1
City: Port Orange
State: Florida
ZIP Code: 32127-2915
Phone: (386) 322-5390

Authorized Official

Name: RUBEN J LOPEZ, MD
Title: PRESIDENT
Phone: (386) 322-5390

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Pediatrics	208000000X	Primary

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