Healthcare Provider Details

I. General information

NPI: 1285840645
Provider Name (Legal Business Name): VARIETY CHILDREN'S HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 06/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 SW 62ND AVE
MIAMI FL
33155-3009
US

IV. Provider business mailing address

3100 SW 62ND AVE
MIAMI FL
33155-3009
US

V. Phone/Fax

Practice location:
  • Phone: 305-663-8538
  • Fax: 305-662-8314
Mailing address:
  • Phone: 305-663-8538
  • Fax: 305-662-8314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number StateFL

VIII. Authorized Official

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