Healthcare Provider Details

I. General information

NPI: 1598826406
Provider Name (Legal Business Name): MIAMI PEDIATRIC HEMATOLOGY ONCOLOGY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 SW 62ND AVE SUITE 121
MIAMI FL
33155-3009
US

IV. Provider business mailing address

3100 SW 62ND AVE SUITE 121
MIAMI FL
33155-3009
US

V. Phone/Fax

Practice location:
  • Phone: 305-662-8360
  • Fax: 305-666-6387
Mailing address:
  • Phone: 305-662-8360
  • Fax: 305-666-6387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: IVY ROCHA
Title or Position: OFFICE MANAGER
Credential:
Phone: 305-663-8551