1124475082 NPI number — KIDZ MEDICAL SERVIES, INC

Table of content: (NPI 1124475082)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124475082 NPI number — KIDZ MEDICAL SERVIES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KIDZ MEDICAL SERVIES, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124475082
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8955 SW 87TH CT
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33176-2230
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-270-1113
Provider Business Practice Location Address Fax Number:
833-464-4210
Provider Enumeration Date:
05/20/2016

Additional Information

Authorized Official

Authorized Official Last Name:
NAVARRO
Authorized Official First Name:
IRENE
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING
Authorized Official Telephone Number:
305-661-1515

Provider Taxonomy Codes

  • Taxonomy code: 2080P0202X , with the licence number:  ME 38928 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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