=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437292521
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PEDIATRIC INFECTIOUS DISEASES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/15/2007
-----------------------------------------------------
Last Update Date | 10/25/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3200 SW 60TH CT SUITE 206
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33155-4000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-662-8378
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3200 SW 60TH CT SUITE 206
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33155-4000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-662-8378
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | OTTO M RAMOS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-662-8378
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2080P0208X
-----------------------------------------------------
Taxonomy Name | Pediatric Infectious Diseases Physician
-----------------------------------------------------
License Number | ME34991
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------