Larry D Mastrogianakis, MD Pediatric And Adolescent Medicine
Pediatrics, Adolescent Medicine in St Augustine, FL. Organization (NPI-2).
NPI number1831970433
StatusActive
Last updated in NPPESOct 10, 2023
Details
- NPI
- 1831970433
- Entity type
- Organization (NPI-2)
- Legal business name
- Larry D Mastrogianakis, MD Pediatric And Adolescent Medicine
- Organization subpart
- No
- Enumeration date
- Oct 10, 2023
- Certification date
- Oct 10, 2023
- Last updated
- Oct 10, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2080A0000X | Pediatrics, Adolescent Medicine | – | – | Yes |
Practice location
101 E Town Pl Ste 215St Augustine, FL 32092-2821
Phone 904-429-9989
Mailing address
101 E Town Pl Ste 215St Augustine, FL 32092-2821
Phone 904-429-9989
Authorized official
Larry D Mastrogianakis
Owner
9044299989
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