Provider Demographics
NPI:1437339231
Name:HOLISTIC PEDIATRICS GROUP LLC
Entity type:Organization
Organization Name:HOLISTIC PEDIATRICS GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AVILIO
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNOZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-879-1985
Mailing Address - Street 1:2906 W TAMPA BAY BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-1233
Mailing Address - Country:US
Mailing Address - Phone:813-879-1985
Mailing Address - Fax:813-876-0336
Practice Address - Street 1:2906 W TAMPA BAY BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-1233
Practice Address - Country:US
Practice Address - Phone:813-879-1985
Practice Address - Fax:813-876-0336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME95639208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty