Aqua Blue Pediatrics PLLC
Pediatrics in Ormond Beach, FL. Organization (NPI-2).
NPI number1619829900
StatusActive
Last updated in NPPESFeb 10, 2026
Details
- NPI
- 1619829900
- Entity type
- Organization (NPI-2)
- Legal business name
- Aqua Blue Pediatrics PLLC
- Organization subpart
- No
- Enumeration date
- Feb 10, 2026
- Certification date
- Feb 10, 2026
- Last updated
- Feb 10, 2026
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 208000000X | Pediatrics | – | – | Yes |
Practice location
785 W Granada Blvd Ste 4Ormond Beach, FL 32174-5163
Phone 630-464-4928
Mailing address
7901 4th St N # 30729St Petersburg, FL 33702-4305
Phone 630-464-4928 · Fax 847-854-9403
Authorized official
Brandon Betancourt
Practice Administrator
8478549402
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