Healthcare Provider Details

I. General information

NPI: 1457415085
Provider Name (Legal Business Name): THE CHILDRENS DOCTOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 JOG RD STE 102
BOYNTON BEACH FL
33437-2981
US

IV. Provider business mailing address

8200 JOG RD STE 102
BOYNTON BEACH FL
33437-2981
US

V. Phone/Fax

Practice location:
  • Phone: 561-738-6284
  • Fax: 561-738-1794
Mailing address:
  • Phone: 561-738-6284
  • Fax: 561-738-1794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME53270
License Number StateFL

VIII. Authorized Official

Name: DR. AMBROSE SOLER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 561-738-6284