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General NPI Number Information
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NPI Number | 1902011141
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Entity Type | Organization
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Legal Business Name | PEDIATRIC HEALTH CENTER
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Dates
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Enumeration Date | 05/11/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1951 SW 172ND AVE
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City | MIRAMAR
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State | FL
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Zip | 33029-5593
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Country | US
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Telephone | 954-441-1144
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Fax |
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Provider Business Mailing Address
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Address Line | 5042 SW 173RD AVE.
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City | MIRAMAR
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State | FL
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Zip | 33029
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Country | US
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Telephone | 954-441-1144
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROGERIO SERRANO FAILLACE
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Credential | M.D
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Telephone | 954-441-1144
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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 77924
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License Number State | FL
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