Provider Demographics
NPI:1043551195
Name:UNIVERSITY PEDIATRICS CENTER, INC
Entity Type:Organization
Organization Name:UNIVERSITY PEDIATRICS CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACINTHA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRILLANTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-966-6000
Mailing Address - Street 1:2301 N UNIVERSITY DR
Mailing Address - Street 2:SUITE 107
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-3617
Mailing Address - Country:US
Mailing Address - Phone:954-966-6000
Mailing Address - Fax:954-966-3473
Practice Address - Street 1:2301 N UNIVERSITY DR
Practice Address - Street 2:SUITE 107
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-3617
Practice Address - Country:US
Practice Address - Phone:954-966-6000
Practice Address - Fax:954-966-3473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-13
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME48959208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD21188OtherUPIN
FL048771600Medicaid