Organization
KIDSVILLE PEDIATRICS III, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. VICTOR M. PANTOJA JR. (ADMINISTRATOR)
(352) 242-1021
Entity
Organization
Contact information
Practice address
1804 OAKLEY SEAVER BLVD, SUITE-C, CLERMONT, FL 34711-1925
(352) 242-1021
(352) 242-1104
Mailing address
1804 OAKLEY SEAVER BLVD, SUITE-C, CLERMONT, FL 34711-1925
(352) 242-1021
(352) 242-1104
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
—
—
208D00000X
General Practice Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001599400
—
FL
05
—
125226800
—
FL
01
—
FL206A
MEDICARE
FL
Enumeration date
02/14/2006
Last updated
01/22/2025
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