Healthcare Provider Details

I. General information

NPI: 1013159268
Provider Name (Legal Business Name): VARIETY CHILDREN'S HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2009
Last Update Date: 04/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13400 SW 120TH ST SUITE 100
MIAMI FL
33186-7440
US

IV. Provider business mailing address

PO BOX 557367
MIAMI FL
33255-7367
US

V. Phone/Fax

Practice location:
  • Phone: 954-385-6200
  • Fax:
Mailing address:
  • Phone: 786-624-5845
  • Fax: 786-624-2688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: PEDRO ALFARO
Title or Position: SENIOR VP & CFO
Credential:
Phone: 305-666-6511