Organization
CSI-PEDIATRIC SERVICES, LLC
Active
Parent organization
PEDIATRIC HOLDINGS, LLC
Other names
CSI Special Care, Spark Pediatrics
Organization subpart
Yes
Provider details
NPI number
Legal business name
PEDIATRIC HOLDINGS, LLC
Authorized official
DONNA LODATO RN (CEO)
(786) 522-9600
Entity
Organization
Contact information
Practice address
1855 CASSAT AVE, JACKSONVILLE, FL 32210-1634
(904) 380-9099
(904) 384-4885
Mailing address
15050 NW 79TH CT STE 201, MIAMI LAKES, FL 33016-5810
(865) 229-6007
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
60080998
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
024128100
—
FL
Enumeration date
12/17/2013
Last updated
07/13/2022
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