Healthcare Provider Details

I. General information

NPI: 1912275488
Provider Name (Legal Business Name): FLORIDA INSTITUTE OF PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2011
Last Update Date: 12/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8765 SW 165TH AVE SUITE 105
MIAMI FL
33193-5831
US

IV. Provider business mailing address

8765 SW 165TH AVE SUITE 105
MIAMI FL
33193-5831
US

V. Phone/Fax

Practice location:
  • Phone: 786-360-2465
  • Fax: 786-360-2966
Mailing address:
  • Phone: 786-360-2465
  • Fax: 786-360-2966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME90107
License Number StateFL

VIII. Authorized Official

Name: DR. NAZLY MONTANO
Title or Position: CEO
Credential: M.D.
Phone: 786-360-2465