Healthcare Provider Details

I. General information

NPI: 1619462991
Provider Name (Legal Business Name): PALM LEAF PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2018
Last Update Date: 07/14/2020
Certification Date: 07/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 SW 93RD AVE STE 210
MIAMI FL
33173-3212
US

IV. Provider business mailing address

7300 SW 93RD AVE STE 210
MIAMI FL
33173-3212
US

V. Phone/Fax

Practice location:
  • Phone: 305-596-3100
  • Fax: 305-596-3909
Mailing address:
  • Phone: 305-596-3100
  • Fax: 305-596-3909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARIA ROBERTA MORO
Title or Position: PRESIDENT
Credential: MD
Phone: 307-622-7756