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General NPI Number Information
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NPI Number | 1487927810
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Entity Type | Organization
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Legal Business Name | NICKLAUS CHILDREN'S HOSPITAL PALM BEACH GARDENS OUTPATIENT CENTER
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Dates
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Enumeration Date | 02/15/2012
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Last Update Date | 03/15/2018
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Provider Practice Location Address
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Address Line | 11310 LEGACY AVE
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33410-3658
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Country | US
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Telephone | 305-666-6511
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 557367
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City | MIAMI
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State | FL
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Zip | 33255-7367
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Country | US
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Telephone | 786-624-5876
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Fax | 786-624-2688
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Authorized Official
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Title or Position | MANAGER, PROVIDER RELATIONS
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Name | RAIZA VIDAURRAZAGA
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Credential |
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Telephone | 786-525-5405
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 282NC2000X
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Taxonomy Name | Children's Hospital
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License Number |
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License Number State |
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