Healthcare Provider Details

I. General information

NPI: 1902694896
Provider Name (Legal Business Name): TMG PEDIATRICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2025
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11904 MIRAMAR PKWY
MIRAMAR FL
33025-7005
US

IV. Provider business mailing address

11904 MIRAMAR PKWY
MIRAMAR FL
33025-7005
US

V. Phone/Fax

Practice location:
  • Phone: 561-709-4978
  • Fax: 561-210-7540
Mailing address:
  • Phone: 561-709-4978
  • Fax: 561-210-7540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: JESSICA LIZAMA
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 561-709-4978