Aqua Blue Pediatrics PLLC

Pediatrics Physician · Ormond Beach, FL

Organization Active NPI

NPI number 1619829900

Practice location

785 W Granada Blvd Ste 4
Ormond Beach, FL 32174-5163
Phone
(630) 464-4928

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NPI record

NPI
1619829900
Entity type
Organization (Type 2)
Enumeration date
February 10, 2026
Last updated
February 10, 2026
Certified
February 10, 2026
Organization subpart
No

Specialties & taxonomy codes

TaxonomyCodeLicenseState
Pediatrics Physician Primary 208000000X — —

Mailing address

7901 4TH St N # 30729
St Petersburg, FL 33702-4305
Phone
(630) 464-4928
Fax
(847) 854-9403

Authorized official

Name
Brandon Betancourt
Title
Practice Administrator
Phone
(847) 854-9402

About Aqua Blue Pediatrics PLLC

Aqua Blue Pediatrics PLLC is a healthcare organization registered in the NPI registry with the primary taxonomy Pediatrics Physician (code 208000000X). The practice location is 785 W Granada Blvd Ste 4, Ormond Beach, FL 32174-5163. The NPI number 1619829900 was assigned on February 10, 2026 and the record was last updated on February 10, 2026.

The authorized official for this organization is Brandon Betancourt, Practice Administrator.

Frequently asked questions

What is the NPI number of Aqua Blue Pediatrics PLLC?

The NPI number is 1619829900.

What is the phone number of Aqua Blue Pediatrics PLLC?

The phone number listed for the practice location is (630) 464-4928.

Where is Aqua Blue Pediatrics PLLC located?

785 W Granada Blvd Ste 4, Ormond Beach, FL 32174-5163.

What is the taxonomy code for Aqua Blue Pediatrics PLLC?

The primary taxonomy code is 208000000X – Pediatrics Physician.

Is this information correct?

All details come from the public NPPES registry. Providers can update their record at nppes.cms.hhs.gov; changes appear here after the next weekly update.

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