MEDICARE: PASADENA PEDIATRICS, P.A.

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	2080A0000X	Pediatric Adolescent Medicine Physician	ME52086	FL

General Provider Information

NPI Number	:	1104928183
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PASADENA PEDIATRICS, P.A.

Provider Business Mailing Address
First Line	:	2476 N UNIVERSITY DR
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33024-3624
Country	:	US
Telephone Number	:	954-436-0068
Fax Number	:	954-431-5006

Provider Business Practice Location Address
First Line	:	2476 N UNIVERSITY DR
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33024-3624
Country	:	US
Telephone Number	:	954-436-0068
Fax Number	:	954-431-5006

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RUFUS JOSEPH
Credential	:
Telephone Number	:	954-436-0068

Provider Enumeration Date	:	09/01/2006
Last Update Date	:	08/22/2020

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