Organization
PEDIATRIC NEUROLOGY PA
Active
Organization
PEDIATRIC NEUROLOGY PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EMMANUEL VEGA (ADMINISTRATOR)
(407) 293-1122
Entity
Organization
Contact information
Practice address
7485 SANDLAKE COMMONS BLVD, ORLANDO, FL 32819-8034
(407) 293-1122
(407) 253-2170
Mailing address
1245 W FAIRBANKS AVE STE 305, WINTER PARK, FL 32789-4878
(407) 293-1122
(407) 253-2170
Taxonomy
Speciality
Code
Description
License number
State
2080P0008X
Pediatric Neurodevelopmental Disabilities Physician
Primary
ME81662
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
280885400
—
FL
Enumeration date
03/27/2008
Last updated
08/05/2020
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