Healthcare Provider Details

I. General information

NPI: 1699984831
Provider Name (Legal Business Name): ROYAL PALM KIDS CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 N STATE ROAD 7 SUITE #305
MARGATE FL
33063-5737
US

IV. Provider business mailing address

2825 N STATE ROAD 7 SUITE #305
MARGATE FL
33063-5737
US

V. Phone/Fax

Practice location:
  • Phone: 954-752-8700
  • Fax: 954-752-0509
Mailing address:
  • Phone: 954-752-8700
  • Fax: 954-752-0509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME0058463
License Number StateFL

VIII. Authorized Official

Name: DAGOBERTO J RODRIGUEZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 954-752-8700