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General NPI Number Information
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NPI Number | 1326294653
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Entity Type | Organization
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Legal Business Name | PEDIATRIC ENDOCRINE AND WELLNESS CENTER, PA
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Dates
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Enumeration Date | 08/18/2008
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Last Update Date | 01/12/2015
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Provider Practice Location Address
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Address Line | 2999 NE 191ST ST SUITE 300
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City | AVENTURA
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State | FL
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Zip | 33180-3123
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Country | US
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Telephone | 305-935-2441
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Fax | 305-935-2388
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Provider Business Mailing Address
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Address Line | 2999 NE 191ST ST SUITE 300
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City | AVENTURA
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State | FL
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Zip | 33180-3123
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Country | US
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Telephone | 305-935-2441
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Fax | 305-935-2388
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. MILAGROS GLORIA HUERTA
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Credential | M.D.
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Telephone | 305-935-2441
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0205X
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Taxonomy Name | Pediatric Endocrinology Physician
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License Number | ME72038
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License Number State | FL
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