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General NPI Number Information
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NPI Number | 1043551195
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Entity Type | Organization
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Legal Business Name | UNIVERSITY PEDIATRICS CENTER, INC
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Dates
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Enumeration Date | 03/13/2013
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Last Update Date | 04/05/2013
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Provider Practice Location Address
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Address Line | 2301 N UNIVERSITY DR SUITE 107
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City | PEMBROKE PINES
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State | FL
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Zip | 33024-3617
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Country | US
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Telephone | 954-966-6000
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Fax | 954-966-3473
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Provider Business Mailing Address
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Address Line | 2301 N UNIVERSITY DR SUITE 107
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City | PEMBROKE PINES
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State | FL
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Zip | 33024-3617
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Country | US
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Telephone | 954-966-6000
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Fax | 954-966-3473
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Authorized Official
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Title or Position | PRESIDENT
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Name | JACINTHA A BRILLANTE
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Credential | MD
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Telephone | 954-966-6000
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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 | ME48959
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License Number State | FL
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