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General NPI Number Information
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NPI Number | 1821800079
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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 | 01/24/2025
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Last Update Date | 01/24/2025
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Provider Practice Location Address
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Address Line | 15420 COLLIER BLVD
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City | NAPLES
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State | FL
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Zip | 34120-3917
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Country | US
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Telephone | 305-663-8439
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Fax |
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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 CCOO
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Name | MARCOS MESTRE
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Credential | MD
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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