MEDICARE: CHILDRENS DIAGNOSTIC & TREATMENT CENTER INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QM1300X	Multi-Specialty Clinic/Center
2	207Q00000X	Family Medicine Physician
3	208000000X	Pediatrics Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437733425
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHILDRENS DIAGNOSTIC & TREATMENT CENTER INC

Provider Business Mailing Address
First Line	:	1700 NW 49TH ST STE 125
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-3750
Country	:	US
Telephone Number	:	954-728-8080
Fax Number	:	954-779-1957

Provider Business Practice Location Address
First Line	:	5201 NW 33RD AVE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-6302
Country	:	US
Telephone Number	:	954-728-8080
Fax Number	:	954-779-1957

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	ANA CALDERON RANDAZZO
Credential	:	PHD
Telephone Number	:	954-728-1060

Provider Enumeration Date	:	05/06/2021
Last Update Date	:	09/18/2024

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Directions to “CHILDRENS DIAGNOSTIC & TREATMENT CENTER INC ” Practice Location

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