=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073789491
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORBERTO PEDROSO MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/06/2008
-----------------------------------------------------
Last Update Date | 01/03/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5078 SW 168TH AVE
-----------------------------------------------------
City | MIRAMAR
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33027-4914
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-458-5612
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5078 SW 168TH AVE
-----------------------------------------------------
City | MIRAMAR
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33027-4914
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-458-5612
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | NORBERTO JESUS PEDROSO MONTESINO
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 305-458-5612
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | ME 100918
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------