Healthcare Provider Details

I. General information

NPI: 1477709970
Provider Name (Legal Business Name): MIAMI CHILDREN'S HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2008
Last Update Date: 02/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17615 SW 97TH AVE
PALMETTO BAY FL
33157-5636
US

IV. Provider business mailing address

17615 SW 97TH AVE
PALMETTO BAY FL
33157-5636
US

V. Phone/Fax

Practice location:
  • Phone: 786-268-2611
  • Fax: 786-268-1748
Mailing address:
  • Phone: 786-268-2611
  • Fax: 786-268-1748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. PEDRO ALFARO
Title or Position: CFO
Credential:
Phone: 305-666-6511