Provider Demographics
NPI:1619358231
Name:OVIEDO PEDIATRICS PLC
Entity type:Organization
Organization Name:OVIEDO PEDIATRICS PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-366-3321
Mailing Address - Street 1:2959 ALAFAYA TRL
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-9482
Mailing Address - Country:US
Mailing Address - Phone:407-366-3321
Mailing Address - Fax:407-359-7616
Practice Address - Street 1:2959 ALAFAYA TRL
Practice Address - Street 2:SUITE 101
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-9482
Practice Address - Country:US
Practice Address - Phone:407-366-3321
Practice Address - Fax:407-359-7616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-10
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL00564872080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL061944200Medicaid