Healthcare Provider Details

I. General information

NPI: 1497885834
Provider Name (Legal Business Name): KENDALL PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 09/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11400 N KENDALL DR SUITE A211
MIAMI FL
33176-1029
US

IV. Provider business mailing address

11400 N KENDALL DR SUITE A211
MIAMI FL
33176-1029
US

V. Phone/Fax

Practice location:
  • Phone: 305-274-2255
  • Fax: 305-274-2211
Mailing address:
  • Phone: 305-274-2255
  • Fax: 305-274-2211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberME 38885
License Number StateFL

VIII. Authorized Official

Name: DR. GUILLERMO JUAN LLOSA
Title or Position: OWNER
Credential: M.D.
Phone: 305-274-2255