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General NPI Number Information
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NPI Number | 1144891045
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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 | 07/02/2021
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 8430 W BROWARD BLVD STE 300
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City | PLANTATION
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State | FL
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Zip | 33324-2700
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Country | US
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Telephone | 954-385-6277
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Fax | 954-217-6317
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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 | 954-385-6277
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Fax | 954-217-6317
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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 |
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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 | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2080P0205X
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Taxonomy Name | Pediatric Endocrinology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2080P0206X
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Taxonomy Name | Pediatric Gastroenterology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #5
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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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