Provider Demographics
NPI:1164256939
Name:OASIS PEDIATRICS LLC
Entity type:Organization
Organization Name:OASIS PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MBWIDIFFU
Authorized Official - Middle Name:A
Authorized Official - Last Name:DIBAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-345-0373
Mailing Address - Street 1:23 S HAMPSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19807-2582
Mailing Address - Country:US
Mailing Address - Phone:302-345-0373
Mailing Address - Fax:
Practice Address - Street 1:700 W LEA BLVD STE 209
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19802-2545
Practice Address - Country:US
Practice Address - Phone:302-762-5656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty