Provider Demographics
NPI:1164769444
Name:ASSOCIATED PEDIATRICIAINS OF HOMESTEAD LLC
Entity Type:Organization
Organization Name:ASSOCIATED PEDIATRICIAINS OF HOMESTEAD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DOURED
Authorized Official - Middle Name:
Authorized Official - Last Name:DAGHISTANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-274-1662
Mailing Address - Street 1:8950 N KENDALL DR
Mailing Address - Street 2:SUITE 603-E
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2144
Mailing Address - Country:US
Mailing Address - Phone:305-274-1662
Mailing Address - Fax:
Practice Address - Street 1:975 BAPTIST WAY
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-7600
Practice Address - Country:US
Practice Address - Phone:305-274-1662
Practice Address - Fax:305-274-0456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care MedicineGroup - Multi-Specialty