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General NPI Number Information
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NPI Number | 1821392077
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Entity Type | Organization
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Legal Business Name | WEST DADE PEDIATRICS LLP
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Dates
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Enumeration Date | 01/03/2011
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Last Update Date | 01/03/2011
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Provider Practice Location Address
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Address Line | 3220 SW 107TH AVE
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City | MIAMI
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State | FL
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Zip | 33165-3606
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Country | US
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Telephone | 305-551-1195
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Fax | 305-551-1094
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Provider Business Mailing Address
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Address Line | 3220 SW 107TH AVE
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City | MIAMI
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State | FL
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Zip | 33165-3606
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Country | US
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Telephone | 305-551-1195
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Fax | 305-551-1094
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Authorized Official
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Title or Position | MAG MEMBER
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Name | DR. JULIO C EGUSQUIZA
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Credential | M.D
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Telephone | 305-551-1195
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME 54356
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License Number State | FL
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