Provider Demographics
NPI:1013577246
Name:PEDIATRIC SPECIALTY GROUP, INC
Entity Type:Organization
Organization Name:PEDIATRIC SPECIALTY GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER RELATIONS SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GABER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-624-5747
Mailing Address - Street 1:3100 SW 62ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-3009
Mailing Address - Country:US
Mailing Address - Phone:305-643-0133
Mailing Address - Fax:305-643-1728
Practice Address - Street 1:4410 W 16TH AVE STE 60
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-7194
Practice Address - Country:US
Practice Address - Phone:305-823-0721
Practice Address - Fax:305-823-2011
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEDIATRIC SPECIALTY GROUP, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-06-19
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty