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General NPI Number Information
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NPI Number | 1235604307
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Entity Type | Organization
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Legal Business Name | KIDZ MEDICAL SERVICES
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Dates
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Enumeration Date | 10/04/2018
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Last Update Date | 07/10/2023
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Provider Practice Location Address
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Address Line | 10521 SW VILLAGE CENTER DR STE 101
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City | PORT ST LUCIE
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State | FL
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Zip | 34987-1930
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Country | US
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Telephone | 561-558-1212
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Fax | 833-464-4219
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Provider Business Mailing Address
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Address Line | 5955 PONCE DE LEON BLVD
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City | CORAL GABLES
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State | FL
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Zip | 33146-2423
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Country | US
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Telephone | 305-661-1515
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Fax | 305-662-3723
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | IRENE NAVARRO
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Credential |
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Telephone | 305-662-3290
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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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