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General NPI Number Information
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NPI Number | 1780138628
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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 | 08/09/2016
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Last Update Date | 04/09/2025
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Provider Practice Location Address
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Address Line | 3100 SW 62ND AVE 3RD FLOOR- BRAIN INSTITUTE
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City | MIAMI
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State | FL
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Zip | 33155
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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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Provider Business Mailing Address
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Address Line | PO BOX 947095
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City | ATLANTA
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State | GA
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Zip | 30394-7095
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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
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Name | MARCOS 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 | 207SG0201X
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Taxonomy Name | Clinical Genetics (M.D.) Physician
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License Number |
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License Number State |
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