Healthcare Provider Details

I. General information

NPI: 1821279357
Provider Name (Legal Business Name): SOUTH FLORIDA PEDIATRIC GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2007
Last Update Date: 12/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6222 SW 8 ST.
MIAMI FL
33144-4810
US

IV. Provider business mailing address

6222 SW 8 ST.
MIAMI FL
33144-4810
US

V. Phone/Fax

Practice location:
  • Phone: 305-221-5115
  • Fax: 305-221-5282
Mailing address:
  • Phone: 305-221-5115
  • Fax: 305-221-5282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: AVIS CAPOTE
Title or Position: OWNER
Credential: MD
Phone: 305-302-3877