Healthcare Provider Details

I. General information

NPI: 1700235637
Provider Name (Legal Business Name): KIDZ MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2016
Last Update Date: 10/19/2023
Certification Date: 10/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

927 45TH ST STE 206
MANGONIA PARK FL
33407-2450
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 561-844-8354
  • Fax: 833-464-4220
Mailing address:
  • Phone: 305-661-1515
  • Fax: 305-662-3723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number
License Number State

VIII. Authorized Official

Name: IRENE NAVARRO
Title or Position: CREDENTIALING
Credential:
Phone: 305-661-1515