Healthcare Provider Details

I. General information

NPI: 1336271527
Provider Name (Legal Business Name): VARIETY CHILDREN'S HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 06/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17615 SW 97 AVE
MIAMI FL
33157-5636
US

IV. Provider business mailing address

PO BOX 557367
MIAMI FL
33255-7367
US

V. Phone/Fax

Practice location:
  • Phone: 786-624-3856
  • Fax: 786-268-1738
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: PEDRO ALFARO
Title or Position: SVP & CFO
Credential:
Phone: 305-669-6422