Healthcare Provider Details

I. General information

NPI: 1902268790
Provider Name (Legal Business Name): GERALDI PEDIATRIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 03/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11246 SW 137TH AVE
MIAMI FL
33186-4201
US

IV. Provider business mailing address

11246 SW 137TH AVE
MIAMI FL
33186-4201
US

V. Phone/Fax

Practice location:
  • Phone: 305-382-0022
  • Fax: 305-383-2174
Mailing address:
  • Phone: 305-382-0022
  • Fax: 305-383-2174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME0055384
License Number StateFL

VIII. Authorized Official

Name: MR. GERMAN FERRER
Title or Position: ADMINISTRATOR
Credential:
Phone: 786-299-9529