Healthcare Provider Details

I. General information

NPI: 1629173943
Provider Name (Legal Business Name): BRICKELL PEDIATRICS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1799 SW 3RD AVE
MIAMI FL
33129-1492
US

IV. Provider business mailing address

1799 SW 3RD AVE
MIAMI FL
33129-1492
US

V. Phone/Fax

Practice location:
  • Phone: 305-858-6626
  • Fax:
Mailing address:
  • Phone: 305-858-6626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME74377
License Number StateFL

VIII. Authorized Official

Name: MONICA REINA
Title or Position: OWNER
Credential: M.D.
Phone: 305-858-3737