MEDICARE: WEST DADE PEDIATRICS

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

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902973464
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST DADE PEDIATRICS

Provider Business Mailing Address
First Line	:	3220 SW 107TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-3606
Country	:	US
Telephone Number	:	305-551-1195
Fax Number	:	305-551-1094

Provider Business Practice Location Address
First Line	:	7150 W 20TH AVE
Second Line	:	SUITE 205
City	:	HIALEAH
State	:	FL
Zip	:	33016-5531
Country	:	US
Telephone Number	:	305-823-0901
Fax Number	:	305-558-5304

Authorized Official
Title or Position	:	PRESIDENTIAL
Name	:	MR. JULIO C EGUSQUIZA
Credential	:	MD
Telephone Number	:	305-823-0901

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	03/27/2025

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Directions to “WEST DADE PEDIATRICS ” Practice Location

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