| Organization Name: | DE LA VEGA PEDIATRICS CORP |
| NPI Number: | 1790066983 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ARNALDO DE LA VEGA (PRESIDENT) |
| Mailing Address: | 31 Barkley Cir Suite 1 Fort Myers |
| State: | FL US |
| Postal Code: | 339077628 |
| Phone Number: | 2392775877 |
| Fax Number: | 2392771354 |
| NPI Enumeration Date: | 09/01/2011 |
| NPI Last Update Date: | 09/01/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | ME101292 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | FL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |