Organization
PEDIATRIC ASSOCIATES OF PETERSBURG PLC
Active
Other names
Infant Jesus Children's Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PATRICIA D GONZALEZ MD (PRESIDENT)
(804) 733-4131
Entity
Organization
Contact information
Practice address
5 HOLLY HILL DR, PETERSBURG, VA 23805-2559
(804) 733-4131
(804) 862-1362
Mailing address
PO BOX 1837, PETERSBURG, VA 23805
(804) 733-4131
(804) 862-1362
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1201542
UNITED HEALTH CARE
—
01
—
1243417
CIGNA PPC
—
01
—
13767
SANTARA
—
01
—
204646
ANTHEM
—
01
—
529
CARENET
—
Enumeration date
07/19/2006
Last updated
08/22/2020
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