MEDICARE: KIDZ MEDICAL SERVICES, INC.

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	2080P0206X	Pediatric Gastroenterology Physician	ME58352	FL

General Provider Information

NPI Number	:	1306191580
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIDZ MEDICAL SERVICES, INC.

Provider Business Mailing Address
First Line	:	5955 PONCE DE LEON BLVD
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33146-2423
Country	:	US
Telephone Number	:	305-661-1515
Fax Number	:	305-662-3723

Provider Business Practice Location Address
First Line	:	3800 JOHNSON ST STE J
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-6030
Country	:	US
Telephone Number	:	954-967-9400
Fax Number	:	833-464-4211

Authorized Official
Title or Position	:	CO-OWNER
Name	:	DR. JORGE PEREZ
Credential	:	MD
Telephone Number	:	305-661-1515

Provider Enumeration Date	:	07/13/2012
Last Update Date	:	07/10/2023

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