Organization
PEDIATRIC ASSOC OF PETERSBURG
Active
Other names
Infant Jesus Childrens Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICIA D GONZALES MD (MEDICAL DIRECTOR)
(804) 530-7413
Entity
Organization
Contact information
Practice address
13213 RIVERS BEND BLVD, CHESTER, VA 23836-8606
(804) 530-7413
(804) 530-7411
Mailing address
13213 RIVERS BEND BLVD, CHESTER, VA 23836-8606
(804) 530-7413
(804) 530-7411
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
0101026123
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002478499004
UNITED HEALTHCARE DR HERM
—
01
—
1201542
UNITED HEALTHCARE DR PATR
—
01
—
1243417
CIGNA DRPATRICIA GONZALES
—
01
—
13767
OPTIMA HEALTH MEDICAID HM
VA
01
—
13767
SENTARA OPTIMA HEALTH DR
—
01
—
2100405
MAMSI DR PATRICIA GONZALE
—
01
—
213114
OPTIMUM CHOICE DR HERMES
—
01
—
2134065
OPTIMUM CHOICE DR TAMARA
—
01
—
23468
SENTARA OPTIMA HEALTH DR
—
01
—
266582
SOUTHERN HEALTH DR PATRIC
—
01
—
306087
SOUTHERN HEALTH DR HERMES
—
01
—
4365024
AETNA DRPATRICIA GONZALES
—
01
—
466594
ANTHEM BLUE CROSS
VA
01
—
5293
CARENET DR PATRICIA GONZA
—
01
—
57968
CARENET DR TAMARA CHARITY
—
01
—
6657468
CIGNA DR TAMARA CHARITY B
—
01
—
6674705
CIGNA DR HERMES DIZON
—
Enumeration date
04/27/2007
Last updated
08/22/2020
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