Healthcare Provider Details

I. General information

NPI: 1508241480
Provider Name (Legal Business Name): CHILDREN'S HEMATOLOGY & ONCOLOGY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2015
Last Update Date: 07/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9980 CENTRAL PARK BLVD. SUITE 206
BOCA RATON FL
33428
US

IV. Provider business mailing address

5955 PONCE DE LEON BLVD
CORAL GABLES FL
33146
US

V. Phone/Fax

Practice location:
  • Phone: 561-844-6363
  • Fax: 561-844-6391
Mailing address:
  • Phone: 305-661-1515
  • Fax: 305-663-5948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number
License Number StateFL

VIII. Authorized Official

Name: MR. JORGE E PEREZ
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 305-661-1515