Organization
ANGEL KIDS PA
Active
Other names
Angel Kids Pediatrics
Organization subpart
No
Provider details
NPI number
Authorized official
AZZA GHANDOUR (BILLING/CREDENTIALING MANAGER)
(904) 242-4220
Entity
Organization
Contact information
Practice address
774 STATE ROAD 13, ST JOHNS, FL 32259-3857
(904) 242-4220
Mailing address
13241 BARTRAM PARK BLVD UNIT 209, JACKSONVILLE, FL 32258-5233
(904) 242-4220
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Enumeration date
06/01/2021
Last updated
06/01/2021
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