Provider Demographics
NPI:1235330507
Name:GOOD SAMARITAN PEDIATRICS
Entity Type:Organization
Organization Name:GOOD SAMARITAN PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GESNER
Authorized Official - Middle Name:
Authorized Official - Last Name:DELVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-653-0013
Mailing Address - Street 1:16800 NW 2ND AVE
Mailing Address - Street 2:SUITE 604
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33169-5549
Mailing Address - Country:US
Mailing Address - Phone:305-653-0013
Mailing Address - Fax:305-653-0590
Practice Address - Street 1:16800 NW 2ND AVE
Practice Address - Street 2:SUITE 604
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33169-5549
Practice Address - Country:US
Practice Address - Phone:305-653-0013
Practice Address - Fax:305-653-0590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0064836208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty