Healthcare Provider Details

I. General information

NPI: 1144537077
Provider Name (Legal Business Name): KIDZ MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2010
Last Update Date: 02/09/2022
Certification Date: 02/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6280 SW 72ND ST STE 607
SOUTH MIAMI FL
33143-4875
US

IV. Provider business mailing address

5955 PONCE DE LEON BLVD
CORAL GABLES FL
33146
US

V. Phone/Fax

Practice location:
  • Phone: 305-661-1515
  • Fax: 305-662-3723
Mailing address:
  • Phone: 305-668-0075
  • Fax: 305-668-6299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License NumberME47855
License Number StateFL

VIII. Authorized Official

Name: LINDSAY MENDIOLA
Title or Position: CFO, COO
Credential:
Phone: 305-661-1515