Healthcare Provider Details

I. General information

NPI: 1750419784
Provider Name (Legal Business Name): NORTHWEST PEDIATRICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 03/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

646 NW 183RD ST
MIAMI FL
33169-4470
US

IV. Provider business mailing address

646 NW 183RD ST
MIAMI FL
33169-4470
US

V. Phone/Fax

Practice location:
  • Phone: 305-493-1600
  • Fax: 305-493-1605
Mailing address:
  • Phone: 305-493-1600
  • Fax: 305-493-1605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberHCC5824
License Number StateFL

VIII. Authorized Official

Name: MRS. DENISE K CASTILLO
Title or Position: ADMINISTRATOR OWNER
Credential:
Phone: 305-493-1600