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General NPI Number Information
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NPI Number | 1972701639
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Entity Type | Organization
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Legal Business Name | SOUTH FLORIDA PEDIATRIC GROUP, INC.
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Dates
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Enumeration Date | 07/04/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8300 W FLAGLER ST SUITE# 258A
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City | MIAMI
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State | FL
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Zip | 33144-6000
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Country | US
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Telephone | 305-965-9236
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 442751
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City | MIAMI
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State | FL
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Zip | 33144-7751
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Country | US
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Telephone | 305-965-9236
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JUDITH VALENCIA
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Credential | M.D.
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Telephone | 305-965-9236
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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 | ME98844
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License Number State | FL
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