Provider Demographics
NPI:1417033077
Name:PLANTATION PEDIATRICS PA
Entity Type:Organization
Organization Name:PLANTATION PEDIATRICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:VIRGINIA
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-431-0131
Mailing Address - Street 1:1851 NW 125TH AVE
Mailing Address - Street 2:SUITE #150
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-2597
Mailing Address - Country:US
Mailing Address - Phone:954-431-0131
Mailing Address - Fax:954-431-3233
Practice Address - Street 1:817 S UNIVERSITY DR
Practice Address - Street 2:STE 101
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324
Practice Address - Country:US
Practice Address - Phone:954-474-5437
Practice Address - Fax:954-472-3783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty