Healthcare Provider Details

I. General information

NPI: 1386956084
Provider Name (Legal Business Name): THE CHILDREN MEDICAL CENTER GROUP INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2010
Last Update Date: 07/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 SW 8TH ST
MIAMI FL
33144-4100
US

IV. Provider business mailing address

8300 SW 8TH ST
MIAMI FL
33144-4100
US

V. Phone/Fax

Practice location:
  • Phone: 305-225-4434
  • Fax: 305-279-9466
Mailing address:
  • Phone: 305-225-4434
  • Fax: 305-279-9466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME14590
License Number StateFL

VIII. Authorized Official

Name: MRS. GILDA MARTINEZ
Title or Position: CORP. SECRETARY
Credential:
Phone: 305-225-4434