=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033271499
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | L&J PEDIATRICS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/14/2006
-----------------------------------------------------
Last Update Date | 08/26/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20338 NW 2ND AVE
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33169-2503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-770-1937
-----------------------------------------------------
Fax | 305-770-1468
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20338 NW 2ND AVE
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33169-2503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-770-1937
-----------------------------------------------------
Fax | 305-770-1468
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MARIA RUIZ-ACEVEDO
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 305-770-1937
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number | ME97464
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------