Healthcare Provider Details

I. General information

NPI: 1689114480
Provider Name (Legal Business Name): KIDZ MEDICAL SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2017
Last Update Date: 02/09/2022
Certification Date: 02/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 SW 148TH AVE SUITE 112
MIRAMAR FL
33027-4181
US

IV. Provider business mailing address

5955 PONCE DE LEON BLVD
CORAL GABLES FL
33146-2423
US

V. Phone/Fax

Practice location:
  • Phone: 954-967-9400
  • Fax: 954-967-9551
Mailing address:
  • Phone: 305-661-1515
  • Fax: 305-663-5948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberME58352
License Number StateFL

VIII. Authorized Official

Name: JORGE E PEREZ
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 305-661-1515