Provider Demographics
NPI:1346830627
Name:PEDIATRIC SPECIALTY GROUP, INC
Entity Type:Organization
Organization Name:PEDIATRIC SPECIALTY GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER RELATIONS SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GABER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-624-5747
Mailing Address - Street 1:3100 SW 62ND AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-3009
Mailing Address - Country:US
Mailing Address - Phone:305-663-8439
Mailing Address - Fax:305-669-6442
Practice Address - Street 1:3100 SW 62ND AVE FL 2
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-3009
Practice Address - Country:US
Practice Address - Phone:305-663-8439
Practice Address - Fax:305-669-6442
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEDIATRIC SPECIALTY GROUP, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency