Healthcare Provider Details

I. General information

NPI: 1609422450
Provider Name (Legal Business Name): BRIGHT SMILES PEDICARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2019
Last Update Date: 08/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2316 S RED RD
MIAMI FL
33155-2207
US

IV. Provider business mailing address

2316 S RED RD
MIAMI FL
33155-2207
US

V. Phone/Fax

Practice location:
  • Phone: 786-631-4926
  • Fax: 786-703-7952
Mailing address:
  • Phone: 786-631-4926
  • Fax: 786-703-7952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM3000X
TaxonomyMedically Fragile Infants and Children Day Care
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. HUASCAR PENA
Title or Position: CEO/OWNER
Credential:
Phone: 786-631-4926