Healthcare Provider Details

I. General information

NPI: 1770516908
Provider Name (Legal Business Name): CHILDRENS UROLOGY ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 05/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 SW 60TH CT SUITE 104
MIAMI FL
33155-4000
US

IV. Provider business mailing address

3200 SW 60TH CT SUITE 104
MIAMI FL
33155-4000
US

V. Phone/Fax

Practice location:
  • Phone: 305-669-6448
  • Fax: 305-663-8485
Mailing address:
  • Phone: 305-669-6448
  • Fax: 305-663-8485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number StateFL

VIII. Authorized Official

Name: EDDA M MOY
Title or Position: OFFICE MANAGER
Credential:
Phone: 305-669-6448