Healthcare Provider Details

I. General information

NPI: 1306191580
Provider Name (Legal Business Name): KIDZ MEDICAL SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2012
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 JOHNSON ST STE J
HOLLYWOOD FL
33021-6030
US

IV. Provider business mailing address

5955 PONCE DE LEON BLVD
CORAL GABLES FL
33146-2423
US

V. Phone/Fax

Practice location:
  • Phone: 954-967-9400
  • Fax: 833-464-4211
Mailing address:
  • Phone: 305-661-1515
  • Fax: 305-662-3723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberME58352
License Number StateFL

VIII. Authorized Official

Name: DR. JORGE PEREZ
Title or Position: CO-OWNER
Credential: MD
Phone: 305-661-1515