Provider Demographics
NPI:1093931651
Name:SIMO AND BRUCK PEDIATRICS,LLC
Entity Type:Organization
Organization Name:SIMO AND BRUCK PEDIATRICS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-791-1935
Mailing Address - Street 1:10111 W FOREST HILL BLVD RM 150
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6157
Mailing Address - Country:US
Mailing Address - Phone:561-791-1935
Mailing Address - Fax:
Practice Address - Street 1:10111 W FOREST HILL BLVD RM 150
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6157
Practice Address - Country:US
Practice Address - Phone:561-791-1935
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty