Healthcare Provider Details

I. General information

NPI: 1952107781
Provider Name (Legal Business Name): PALM BEACH PEDIATRICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7613 NW 57TH ST
SUNRISE FL
33351-4338
US

IV. Provider business mailing address

2000 PALM BEACH LAKES BLVD STE 901
WEST PALM BEACH FL
33409-6506
US

V. Phone/Fax

Practice location:
  • Phone: 561-509-5009
  • Fax:
Mailing address:
  • Phone: 561-509-5009
  • 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: ELIZABETH LARSEN
Title or Position: HEAD OF PRACTICE OPERATIONS
Credential:
Phone: 319-936-6898