Healthcare Provider Details

I. General information

NPI: 1174742613
Provider Name (Legal Business Name): PEDI PEC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6738 W SUNRISE BLVD
PLANTATION FL
33313-6070
US

IV. Provider business mailing address

1450 NW 159TH ST
MIAMI FL
33169-5727
US

V. Phone/Fax

Practice location:
  • Phone: 954-587-1210
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number60080981
License Number StateFL

VIII. Authorized Official

Name: GRISELDA MILLER
Title or Position: PRESIDENT
Credential:
Phone: 305-623-1222