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General NPI Number Information
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NPI Number | 1013577246
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Entity Type | Organization
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Legal Business Name | NICKLAUS CHILDREN'S PEDIATRIC SPECIALISTS, LLC
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Dates
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Enumeration Date | 06/19/2019
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Last Update Date | 11/06/2024
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Provider Practice Location Address
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Address Line | 4410 W 16TH AVE STE 60
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City | HIALEAH
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State | FL
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Zip | 33012-7194
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Country | US
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Telephone | 305-823-0721
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Fax | 305-823-2011
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Provider Business Mailing Address
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Address Line | 3100 SW 62ND AVE
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City | MIAMI
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State | FL
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Zip | 33155-3009
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Country | US
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Telephone | 305-643-0133
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Fax | 305-643-1728
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Authorized Official
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Title or Position | PROVIDER RELATIONS SPECIALIST
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Name | LAURA M GABER
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Credential |
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Telephone | 786-624-5747
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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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