Healthcare Provider Details

I. General information

NPI: 1326294653
Provider Name (Legal Business Name): PEDIATRIC ENDOCRINE AND WELLNESS CENTER, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2008
Last Update Date: 01/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2999 NE 191ST ST SUITE 300
AVENTURA FL
33180-3123
US

IV. Provider business mailing address

2999 NE 191ST ST SUITE 300
AVENTURA FL
33180-3123
US

V. Phone/Fax

Practice location:
  • Phone: 305-935-2441
  • Fax: 305-935-2388
Mailing address:
  • Phone: 305-935-2441
  • Fax: 305-935-2388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberME72038
License Number StateFL

VIII. Authorized Official

Name: DR. MILAGROS GLORIA HUERTA
Title or Position: DIRECTOR
Credential: M.D.
Phone: 305-935-2441