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General NPI Number Information
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NPI Number | 1669354379
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Entity Type | Organization
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Legal Business Name | NICKLAUS CHILDREN'S PEDIATRIC SPECIALISTS, LLC
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Dates
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Enumeration Date | 07/23/2025
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Last Update Date | 07/24/2025
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Provider Practice Location Address
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Address Line | 3000 CORAL HILLS DR
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City | CORAL SPRINGS
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State | FL
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Zip | 33065-4108
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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 | 3100 SW 62ND AVE
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City | MIAMI
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State | FL
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Zip | 33155-3009
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SVP/CCOO
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Name | MARK MESTRE
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Credential |
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Telephone | 305-666-6511
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XP3100X
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Taxonomy Name | Pediatric Orthopaedic Surgery Physician
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License Number |
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License Number State |
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