Organization
CSI-PEDIATRIC SERVICES, LLC
Active
Parent organization
PEDIATRIC HOLDINGS, LLC
Other names
Spark Pediatrics, CSI-SPECIAL CARE
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
3040 DYER BLVD, SUITE 3028, 3030, KISSIMMEE, FL 34741-7839
(407) 279-1668
Mailing address
15050 NW 79TH CT STE 201, MIAMI LAKES, FL 33016-5810
(786) 522-9600
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
024131700
—
FL
Enumeration date
08/29/2016
Last updated
07/13/2022
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