Healthcare Provider Details

I. General information

NPI: 1861765828
Provider Name (Legal Business Name): BOCA DEL MAR PEDIATRIC AND ADOLESCENT CENTER PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2012
Last Update Date: 02/05/2026
Certification Date: 02/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21301 POWERLINE RD STE 106
BOCA RATON FL
33433-2389
US

IV. Provider business mailing address

21301 POWERLINE RD STE 106
BOCA RATON FL
33433-2389
US

V. Phone/Fax

Practice location:
  • Phone: 866-550-2212
  • Fax: 561-516-7362
Mailing address:
  • Phone: 866-550-2212
  • Fax: 561-516-7362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MEGAN EMSALEM
Title or Position: MANAGER
Credential:
Phone: 866-550-2212