Provider Demographics
NPI:1558588046
Name:E G PEDIATRICS, P.A.
Entity Type:Organization
Organization Name:E G PEDIATRICS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTHA ROSA
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTRADA-GUEVARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-229-9191
Mailing Address - Street 1:11880 SW 40TH ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-3584
Mailing Address - Country:US
Mailing Address - Phone:305-229-9191
Mailing Address - Fax:305-229-9145
Practice Address - Street 1:11880 SW 40TH ST
Practice Address - Street 2:SUITE 205
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3584
Practice Address - Country:US
Practice Address - Phone:305-229-9191
Practice Address - Fax:305-229-9145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherEIN