Provider Demographics
NPI:1093111262
Name:PEDIATRIC GERIATRIC COMMUNICATIONS DISORDERS, INC
Entity Type:Organization
Organization Name:PEDIATRIC GERIATRIC COMMUNICATIONS DISORDERS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:NAVAL
Authorized Official - Last Name:PEREZ HENRIQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:786-506-4154
Mailing Address - Street 1:19845 NW 54TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-6156
Mailing Address - Country:US
Mailing Address - Phone:786-506-4154
Mailing Address - Fax:786-916-5858
Practice Address - Street 1:19845 NW 54TH PL
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33055-6156
Practice Address - Country:US
Practice Address - Phone:786-506-4154
Practice Address - Fax:786-916-5858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-14
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty