Organization Name: | HEARTLAND PEDIATRICS OF LAKE WALES, L.L.C., |
NPI Number: | 1104989680 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | RAJESWARI SONNI (OFFICER AND MEDICAL DIRECTOR) |
Mailing Address: | 1354 State Road 60 E Lake Wales |
State: | FL US |
Postal Code: | 338534322 |
Phone Number: | 8636798888 |
Fax Number: | 8636762851 |
NPI Enumeration Date: | 12/18/2006 |
NPI Last Update Date: | 09/04/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QR1300X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Rural Health |
Taxonomy Definition: |