| Central Florida Pediatric | |
|
3021 W Eau Gallie Blvd Ste 101 Melbourne FL 32934-7005 | |
| (352) 328-6127 | |
| Not Available |
| Full Name | Central Florida Pediatric |
|---|---|
| Speciality | Pediatrics |
| Location | 3021 W Eau Gallie Blvd Ste 101, Melbourne, Florida |
| Authorized Official Name and Position | Faris Mahmoud Al-mousily (ADMINISTRATOR) |
| Authorized Official Contact | 3523286127 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Central Florida Pediatric 12386 State Road 535 # 422 Orlando FL 32836-6701 Ph: (352) 328-6127 | Central Florida Pediatric 3021 W Eau Gallie Blvd Ste 101 Melbourne FL 32934-7005 Ph: (352) 328-6127 |
| NPI Number | 1295308385 |
|---|---|
| Provider Enumeration Date | 07/19/2021 |
| Last Update Date | 10/03/2022 |
| Medicare PECOS PAC ID | 0941690820 |
|---|---|
| Medicare Enrollment ID | O20211208001654 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295308385 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| 2080P0202X | Pediatrics - Pediatric Cardiology | (* (Not Available)) | Primary |
| Provider Name | Faris Al Mousily |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1114025301 PECOS PAC ID: 1456446723 Enrollment ID: I20071002000009 |
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