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General NPI Number Information
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NPI Number | 1841867645
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Entity Type | Organization
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Legal Business Name | EVOLVE PEDIATRIC PPEC, LLC
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Dates
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Enumeration Date | 06/09/2021
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Last Update Date | 06/09/2021
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Provider Practice Location Address
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Address Line | 15273 SW 28TH TER
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City | MIAMI
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State | FL
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Zip | 33185-5673
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Country | US
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Telephone | 786-443-9749
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Fax | 786-353-2757
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Provider Business Mailing Address
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Address Line | 15273 SW 28TH TER
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City | MIAMI
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State | FL
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Zip | 33185-5673
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Country | US
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Telephone | 786-443-9749
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Fax | 786-353-2757
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | MR. VICTOR M PENA
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Credential |
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Telephone | 786-443-9749
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM3000X
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Taxonomy Name | Medically Fragile Infants and Children Day Care
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License Number |
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License Number State |
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