Organization
DE LA VEGA PEDIATRICS, CORP.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TATIANA DE LA VEGA (OFFICE MANAGER)
(239) 277-5877
Entity
Organization
Contact information
Practice address
12781 WORLD PLAZA LN STE 1, FORT MYERS, FL 33907-4078
(239) 277-5877
(239) 277-1354
Mailing address
12781 WORLD PLAZA LN STE 1, FORT MYERS, FL 33907-4078
(239) 277-5877
(239) 277-1354
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
ME101292
FL
208D00000X
General Practice Physician
Primary
ME101292
FL
Other
Enumeration date
09/01/2011
Last updated
03/25/2023
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