Organization
THE PEDIATRIC CENTER
Active
Other names
The Pediatric Center
Organization subpart
No
Provider details
NPI number
Authorized official
ALI I KHOSRAVANI M.D. (SEC-TREASURY)
(561) 790-2600
Entity
Organization
Contact information
Practice address
1447 MEDICAL PARK BLVD., SUITE 402, WELLINGTON, FL 33414
(561) 790-2600
(561) 798-2857
Mailing address
1447 MEDICAL PARK BLVD, SUITE 402, WELLINGTON, FL 33414
(561) 790-2600
(561) 790-1535
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
176316
HEALTHEASE
FL
01
—
205500
AMERIGROUP
FL
05
—
378772900
—
FL
05
—
378772901
—
FL
Enumeration date
06/17/2006
Last updated
12/30/2015
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