Healthcare Provider Details

I. General information

NPI: 1275684003
Provider Name (Legal Business Name): PEDIATRIC EMERGENCY CONSULTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 N KENDALL DR
MIAMI FL
33176-2118
US

IV. Provider business mailing address

5995 SW 91ST ST
MIAMI FL
33156-2042
US

V. Phone/Fax

Practice location:
  • Phone: 786-596-3677
  • Fax:
Mailing address:
  • Phone: 305-661-2824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number1941112
License Number StateFL

VIII. Authorized Official

Name: DR. FRANCISCO A MEDINA
Title or Position: DIRECTOR
Credential: MD
Phone: 786-596-3677