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General NPI Number Information
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NPI Number | 1003488412
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Entity Type | Organization
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Legal Business Name | PEDIATRIC ENDOCRINE AND METABOLIC CENTER OF FLORIDA, PLLC
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Dates
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Enumeration Date | 07/14/2021
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Last Update Date | 08/21/2023
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Provider Practice Location Address
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Address Line | 9401 SW DISCOVERY WAY STE 102
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City | PORT ST LUCIE
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State | FL
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Zip | 34987-2381
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Country | US
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Telephone | 772-834-7362
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Fax | 772-618-2024
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Provider Business Mailing Address
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Address Line | 9401 SW DISCOVERY WAY STE 102
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City | PORT ST LUCIE
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State | FL
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Zip | 34987-2381
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Country | US
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Telephone | 772-834-7362
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Fax | 772-618-2024
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Authorized Official
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Title or Position | OWNER
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Name | DR. MILADYS MIRIAM PALAU COLLAZO
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Credential | MD
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Telephone | 772-834-7362
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2080P0205X
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Taxonomy Name | Pediatric Endocrinology Physician
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License Number |
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License Number State |
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