Provider Demographics
NPI:1114982899
Name:EAST/WEST PEDIATRICS, P.A.
Entity type:Organization
Organization Name:EAST/WEST PEDIATRICS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RAGINI
Authorized Official - Middle Name:
Authorized Official - Last Name:DHARMAPPA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-452-7576
Mailing Address - Street 1:106 NW 100TH AVE
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-7008
Mailing Address - Country:US
Mailing Address - Phone:954-452-7576
Mailing Address - Fax:954-452-8248
Practice Address - Street 1:106 NW 100TH AVE
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-7008
Practice Address - Country:US
Practice Address - Phone:954-452-7576
Practice Address - Fax:954-452-8248
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAST/WEST PEDIATRICS, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-18
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0037089208000000X
FLME0037416208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME0037089OtherSTATE LICENSE
FLME0037416OtherST LICENSE