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General NPI Number Information
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NPI Number | 1508226879
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Entity Type | Organization
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Legal Business Name | MAMIPEDIATRICS LLC
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Dates
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Enumeration Date | 03/01/2016
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Last Update Date | 03/01/2016
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Provider Practice Location Address
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Address Line | 2020 NE 163RD ST STE 105
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33162-4927
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Country | US
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Telephone | 305-790-9058
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Fax |
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Provider Business Mailing Address
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Address Line | 21659 MARIGOT DR
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City | BOCA RATON
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State | FL
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Zip | 33428-4825
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Country | US
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Telephone | 602-363-6312
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SULTANA ALKON
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Credential | MD
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Telephone | 602-363-6312
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME 126460
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License Number State | FL
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