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General NPI Number Information
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NPI Number | 1902973464
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Entity Type | Organization
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Legal Business Name | WEST DADE PEDIATRICS
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Dates
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Enumeration Date | 11/29/2006
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Last Update Date | 03/27/2025
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Provider Practice Location Address
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Address Line | 7150 W 20TH AVE SUITE 205
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City | HIALEAH
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State | FL
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Zip | 33016-5531
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Country | US
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Telephone | 305-823-0901
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Fax | 305-558-5304
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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 | PRESIDENTIAL
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Name | MR. JULIO C EGUSQUIZA
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Credential | MD
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Telephone | 305-823-0901
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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 |
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License Number State |
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