Provider Demographics
NPI:1629173943
Name:BRICKELL PEDIATRICS, P.A.
Entity Type:Organization
Organization Name:BRICKELL PEDIATRICS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:REINA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-858-3737
Mailing Address - Street 1:1799 SW 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33129-1492
Mailing Address - Country:US
Mailing Address - Phone:305-858-6626
Mailing Address - Fax:
Practice Address - Street 1:1799 SW 3RD AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33129-1492
Practice Address - Country:US
Practice Address - Phone:305-858-6626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME74377208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL42903OtherBCBS
FL293016OtherAVMED
FL7238275OtherAETNA
FL114901OtherHUMANA
FL1270005OtherUNITED HEALTH CARE