Healthcare Provider Details

I. General information

NPI: 1356795884
Provider Name (Legal Business Name): VARIETY CHILDREN'S HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2016
Last Update Date: 04/21/2016
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

PO BOX 864844
ORLANDO FL
32886-4844
US

V. Phone/Fax

Practice location:
  • Phone: 786-624-4523
  • Fax: 786-624-4979
Mailing address:
  • Phone: 786-624-4523
  • Fax: 786-624-4979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY BIRKENSTOCK
Title or Position: SVP AND CFO
Credential:
Phone: 786-624-6422