Healthcare Provider Details

I. General information

NPI: 1104928183
Provider Name (Legal Business Name): PASADENA PEDIATRICS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2476 N UNIVERSITY DR
PEMBROKE PINES FL
33024-3624
US

IV. Provider business mailing address

2476 N UNIVERSITY DR
PEMBROKE PINES FL
33024-3624
US

V. Phone/Fax

Practice location:
  • Phone: 954-436-0068
  • Fax: 954-431-5006
Mailing address:
  • Phone: 954-436-0068
  • Fax: 954-431-5006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberME52086
License Number StateFL

VIII. Authorized Official

Name: DR. RUFUS JOSEPH
Title or Position: OWNER
Credential:
Phone: 954-436-0068