1306097407 NPI number — RS PEDIATRICS, LLC

Table of content: (NPI 1306097407)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306097407 NPI number — RS PEDIATRICS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RS PEDIATRICS, LLC
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:
1306097407
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 833416
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33283-3416
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-273-0026
Provider Business Mailing Address Fax Number:
305-273-0388

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8940 N KENDALL DR
Provider Second Line Business Practice Location Address:
SUITE 603E
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33176-2148
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-273-0026
Provider Business Practice Location Address Fax Number:
305-273-0388
Provider Enumeration Date:
10/07/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SAN JORGE
Authorized Official First Name:
ANTONIA
Authorized Official Middle Name:
R
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
305-273-0026

Provider Taxonomy Codes

  • Taxonomy code: 2080P0203X , with the licence number:  ME0075180 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080P0208X , with the licence number: ME56516 , 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)