Healthcare Provider Details

I. General information

NPI: 1114982899
Provider Name (Legal Business Name): EAST/WEST PEDIATRICS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 05/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 NW 100TH AVE
PLANTATION FL
33324-7008
US

IV. Provider business mailing address

106 NW 100TH AVE
PLANTATION FL
33324-7008
US

V. Phone/Fax

Practice location:
  • Phone: 954-452-7576
  • Fax: 954-452-8248
Mailing address:
  • Phone: 954-452-7576
  • Fax: 954-452-8248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME0037089
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME0037416
License Number StateFL

VIII. Authorized Official

Name: MRS. RAGINI DHARMAPPA
Title or Position: OFFICE MANAGER
Credential:
Phone: 954-452-7576