1497885834 NPI number — KENDALL PEDIATRICS

Table of content: (NPI 1497885834)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497885834 NPI number — KENDALL PEDIATRICS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KENDALL PEDIATRICS
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:
6
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:
1497885834
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/24/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11400 N KENDALL DR
Provider Second Line Business Mailing Address:
SUITE A211
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33176-1029
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-274-2255
Provider Business Mailing Address Fax Number:
305-274-2211

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11400 N KENDALL DR
Provider Second Line Business Practice Location Address:
SUITE A211
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33176-1029
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-274-2255
Provider Business Practice Location Address Fax Number:
305-274-2211
Provider Enumeration Date:
03/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LLOSA
Authorized Official First Name:
GUILLERMO
Authorized Official Middle Name:
JUAN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
305-274-2255

Provider Taxonomy Codes

  • Taxonomy code: 2080A0000X , with the licence number:  ME 38885 , 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)

  • Identifier: 275521100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 275116000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1063475887 . This is a "NPI ALINA SIBLESZ RUIZ MD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1720077308 . This is a "NPI GUILLERMO LLOSA, MD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 266165900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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