Healthcare Provider Details

I. General information

NPI: 1902973464
Provider Name (Legal Business Name): WEST DADE PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 03/27/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7150 W 20TH AVE SUITE 205
HIALEAH FL
33016-5531
US

IV. Provider business mailing address

3220 SW 107TH AVE
MIAMI FL
33165-3606
US

V. Phone/Fax

Practice location:
  • Phone: 305-823-0901
  • Fax: 305-558-5304
Mailing address:
  • Phone: 305-551-1195
  • Fax: 305-551-1094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JULIO C EGUSQUIZA
Title or Position: PRESIDENTIAL
Credential: MD
Phone: 305-823-0901