Healthcare Provider Details

I. General information

NPI: 1780349712
Provider Name (Legal Business Name): PEDIKIDZ OF FLORIDA CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2021
Last Update Date: 11/22/2021
Certification Date: 11/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2311 10TH AVE N STE 12
LAKE WORTH FL
33461-6605
US

IV. Provider business mailing address

9301 SW 56TH ST STE C
MIAMI FL
33165-6559
US

V. Phone/Fax

Practice location:
  • Phone: 305-596-1088
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: REBECCA BELTRAN
Title or Position: OWNER
Credential:
Phone: 305-591-0188