Healthcare Provider Details

I. General information

NPI: 1336722982
Provider Name (Legal Business Name): MY WAY PEDIATRICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2021
Last Update Date: 05/02/2021
Certification Date: 05/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 ROYAL PALM BEACH BLVD
ROYAL PALM BEACH FL
33411-1608
US

IV. Provider business mailing address

4695 MANDERLY DR
WELLINGTON FL
33449-7406
US

V. Phone/Fax

Practice location:
  • Phone: 561-777-5246
  • Fax: 561-484-5752
Mailing address:
  • Phone: 702-756-9994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: JUAN C COLLAZOS-RODRIGUEZ
Title or Position: PEDIATRICIAN
Credential: MD
Phone: 702-756-9994