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General NPI Number Information
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NPI Number | 1144941048
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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 | 09/08/2022
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 7800 SW 87TH AVE # C-350
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City | MIAMI
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State | FL
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Zip | 33173-3570
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Country | US
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Telephone | 305-271-4711
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Fax |
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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 | 786-627-5747
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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 MESTREE
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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 | 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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