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General NPI Number Information
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NPI Number | 1184884918
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Entity Type | Organization
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Legal Business Name | KOOL KIDZ PEDIATRICS
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Dates
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Enumeration Date | 06/16/2008
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Last Update Date | 06/16/2008
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Provider Practice Location Address
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Address Line | 1951 SW 172ND AVE SUITE 410
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City | MIRAMAR
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State | FL
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Zip | 33029-5593
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Country | US
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Telephone | 954-433-1966
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Fax | 954-433-3466
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Provider Business Mailing Address
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Address Line | 1951 SW 172ND AVE SUITE 410
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City | MIRAMAR
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State | FL
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Zip | 33029-5593
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Country | US
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Telephone | 954-433-1966
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Fax | 954-433-3466
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | VALIA MORENO
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Credential |
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Telephone | 954-433-1966
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | ME73747
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License Number State | FL
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