Healthcare Provider Details

I. General information

NPI: 1902108749
Provider Name (Legal Business Name): PEDIATRIC PULMONARY AND ASTHMA SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2010
Last Update Date: 11/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20776 W DIXIE HWY
MIAMI FL
33180-1146
US

IV. Provider business mailing address

20776 W DIXIE HWY
MIAMI FL
33180-1146
US

V. Phone/Fax

Practice location:
  • Phone: 905-931-1812
  • Fax: 305-931-1632
Mailing address:
  • Phone: 905-931-1812
  • Fax: 305-931-1632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License NumberME0069331
License Number StateFL

VIII. Authorized Official

Name: DR. MARIO RUB
Title or Position: PRESIDENT
Credential: M.D.
Phone: 305-931-1812