Healthcare Provider Details

I. General information

NPI: 1154712198
Provider Name (Legal Business Name): PEDIATRIC &ADOLESCENT MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2015
Last Update Date: 02/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7150 W 20TH AVE STE 612
HIALEAH FL
33016-5534
US

IV. Provider business mailing address

7150 W 20TH AVE STE 612
HIALEAH FL
33016-5534
US

V. Phone/Fax

Practice location:
  • Phone: 305-827-1561
  • Fax:
Mailing address:
  • Phone: 305-827-1561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberME0063187
License Number StateFL

VIII. Authorized Official

Name: DR. ROBERT BELLAMINE O'NEILL
Title or Position: DOCTOR
Credential: M.D.
Phone: 305-827-1561