Healthcare Provider Details

I. General information

NPI: 1295981884
Provider Name (Legal Business Name): SPECIAL CARE PEDIATRICS CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2008
Last Update Date: 08/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10240 SW 56TH ST STE 102
MIAMI FL
33165-7071
US

IV. Provider business mailing address

10240 SW 56TH ST STE 102
MIAMI FL
33165-7071
US

V. Phone/Fax

Practice location:
  • Phone: 305-275-6070
  • Fax:
Mailing address:
  • Phone: 305-275-6070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME68713
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME68713
License Number StateFL

VIII. Authorized Official

Name: MARIA E MEDINA CAPOTE
Title or Position: MD
Credential: MD
Phone: 305-275-6070