Provider Demographics
NPI:1679604904
Name:FLORIDA PEDIATRIC GASTROENTEROLOGY GROUP, P.L.
Entity type:Organization
Organization Name:FLORIDA PEDIATRIC GASTROENTEROLOGY GROUP, P.L.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-482-2092
Mailing Address - Street 1:9980 N. CENTRAL PARK BLVD.
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428
Mailing Address - Country:US
Mailing Address - Phone:561-482-7038
Mailing Address - Fax:
Practice Address - Street 1:9980 N. CENTRAL PARK BLVD.
Practice Address - Street 2:SUITE 202
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428
Practice Address - Country:US
Practice Address - Phone:561-482-7038
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric GastroenterologyGroup - Single Specialty