Healthcare Provider Details

I. General information

NPI: 1306881610
Provider Name (Legal Business Name): PEDIATRIC EMERGENCY CONSULTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 01/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 N KENDALL DR
MIAMI FL
33176-2118
US

IV. Provider business mailing address

PO BOX 198450
ATLANTA GA
30384-8450
US

V. Phone/Fax

Practice location:
  • Phone: 786-596-6299
  • Fax: 786-596-3682
Mailing address:
  • Phone: 305-503-6320
  • Fax: 305-503-6329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberME53534
License Number StateFL

VIII. Authorized Official

Name: FRANCISCO MEDINA-MEJIA
Title or Position: DIRECTOR
Credential: MD
Phone: 786-596-6299