Healthcare Provider Details

I. General information

NPI: 1326587601
Provider Name (Legal Business Name): FIT LIFE PEDIATRIC CONSULTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2017
Last Update Date: 04/20/2024
Certification Date: 04/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9020 SW 137TH AVE STE 200
MIAMI FL
33186-1430
US

IV. Provider business mailing address

9020 SW 137TH AVE STE 200
MIAMI FL
33186-1430
US

V. Phone/Fax

Practice location:
  • Phone: 305-777-3505
  • Fax: 786-866-2599
Mailing address:
  • Phone: 305-777-3505
  • Fax: 786-866-2599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS10933
License Number StateFL

VIII. Authorized Official

Name: DR. DAMARIS MAFUT
Title or Position: PRESIDENT
Credential: D.O
Phone: 305-777-3505