Healthcare Provider Details

I. General information

NPI: 1720293822
Provider Name (Legal Business Name): KIDZ-IN PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3170 N FEDERAL HWY SUITE 214
LIGHTHOUSE POINT FL
33064-6700
US

IV. Provider business mailing address

5042 SOUTHWEST 173RD AVENUE
MIRAMAR FL
33029
US

V. Phone/Fax

Practice location:
  • Phone: 954-786-2200
  • Fax:
Mailing address:
  • Phone: 954-786-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME 77924
License Number StateFL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: ROGERIO SERRANO FAILLACE
Title or Position: DOCTOR
Credential: M.D.
Phone: 954-786-2200