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General NPI Number Information
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NPI Number | 1912720186
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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 | 11/05/2024
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 10230 W STATE ROAD 84
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City | DAVIE
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State | FL
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Zip | 33324-4202
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Country | US
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Telephone | 305-666-6511
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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
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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 | 207XP3100X
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Taxonomy Name | Pediatric Orthopaedic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207YP0228X
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Taxonomy Name | Pediatric Otolaryngology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2080P0206X
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Taxonomy Name | Pediatric Gastroenterology Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 2084N0402X
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Taxonomy Name | Neurology with Special Qualifications in Child Neurology Physician
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number |
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License Number State |
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