MEDICARE: NICKLAUS CHILDREN'S PEDIATRIC SPECIALISTS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1063398857
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NICKLAUS CHILDREN'S PEDIATRIC SPECIALISTS, LLC

Provider Business Mailing Address
First Line	:	3100 SW 62ND AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33155-3009
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	998 N FEDERAL HWY
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33062-4342
Country	:	US
Telephone Number	:	954-941-5731
Fax Number	:

Authorized Official
Title or Position	:	SVP/COO
Name	:	MARCOS MESTRE
Credential	:
Telephone Number	:	305-666-6511

Provider Enumeration Date	:	08/15/2025
Last Update Date	:	08/15/2025

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