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General NPI Number Information
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NPI Number | 1023714359
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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 | 02/07/2023
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 11011 SHERIDAN ST STE 311
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City | COOPER CITY
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State | FL
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Zip | 33026-1532
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Country | US
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Telephone | 954-435-7400
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 947095
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City | ATLANTA
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State | GA
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Zip | 30394-7095
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SVP
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Name | MARCOS MESTRE
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Credential | MD
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Telephone | 305-666-6511
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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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