Healthcare Provider Details

I. General information

NPI: 1841512837
Provider Name (Legal Business Name): MEDICAL CENTER FOR CHILDREN, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2010
Last Update Date: 03/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8198 JOG RD SUITE 102B
BOYNTON BEACH FL
33472-2900
US

IV. Provider business mailing address

8198 JOG RD SUITE 102B
BOYNTON BEACH FL
33472-2900
US

V. Phone/Fax

Practice location:
  • Phone: 561-736-2292
  • Fax: 561-274-0021
Mailing address:
  • Phone: 561-736-2292
  • Fax: 561-274-0021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME74443
License Number StateFL

VIII. Authorized Official

Name: DR. CARLINE ST. LOUIS-MOISE
Title or Position: PRESIDENT
Credential: MD
Phone: 561-736-2292