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General NPI Number Information
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NPI Number | 1184638819
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Entity Type | Organization
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Legal Business Name | PEDI PEC
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 15839 NW 2ND AVE
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City | MIAMI
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State | FL
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Zip | 33169-6711
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Country | US
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Telephone | 305-948-5683
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Fax |
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Provider Business Mailing Address
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Address Line | 1450 NW 159TH ST
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City | MIAMI
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State | FL
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Zip | 33169-5727
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Country | US
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Telephone | 305-623-1222
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. GRISELDA MILLER
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Credential |
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Telephone | 305-623-1222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385HR2065X
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Taxonomy Name | Child Physical Disabilities Respite Care
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License Number | 60080975
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License Number State | FL
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