Healthcare Provider Details

I. General information

NPI: 1083927537
Provider Name (Legal Business Name): MCH PEDIATRIC CARDIOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2010
Last Update Date: 07/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12989 SOUTHERN BOULEVARD PALMS WEST MOB III SUITE 203
LOXAHATCHEE FL
33470
US

IV. Provider business mailing address

PO BOX 557367
MIAMI FL
33255-7367
US

V. Phone/Fax

Practice location:
  • Phone: 561-383-7113
  • Fax:
Mailing address:
  • Phone: 786-624-5845
  • Fax: 786-624-2688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: PEDRO ALFARO
Title or Position: SENIOR VP & CFO
Credential:
Phone: 305-666-6511