Provider Demographics
NPI:1386821296
Name:MARIO JOSE QUIROS MEMORIAL PEDIATRICS
Entity Type:Organization
Organization Name:MARIO JOSE QUIROS MEMORIAL PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:I
Authorized Official - Last Name:QUIROS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-438-1999
Mailing Address - Street 1:1951 SW 172ND AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33029-5593
Mailing Address - Country:US
Mailing Address - Phone:954-438-1999
Mailing Address - Fax:954-438-4404
Practice Address - Street 1:1951 SW 172ND AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33029-5593
Practice Address - Country:US
Practice Address - Phone:954-438-1999
Practice Address - Fax:954-438-4404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty