Healthcare Provider Details

I. General information

NPI: 1447382676
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: 09/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 SW 62ND AVE DEPARTMENT OF ORTHOPEDICS
MIAMI FL
33155-3009
US

IV. Provider business mailing address

PO BOX 865095
ORLANDO FL
32886-5095
US

V. Phone/Fax

Practice location:
  • Phone: 305-662-8366
  • Fax: 305-663-9194
Mailing address:
  • Phone: 786-624-5876
  • Fax: 786-624-2688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number574498-3
License Number StateFL

VIII. Authorized Official

Name: ELIZABETH MENOCAL
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 305-662-8357