Provider Demographics
NPI:1629780309
Name:MINI MIRACLES PEDIATRICS MEDICAL DAYCARE INC
Entity Type:Organization
Organization Name:MINI MIRACLES PEDIATRICS MEDICAL DAYCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-319-5353
Mailing Address - Street 1:28410 BONITA CROSSINGS BLVD UNIT 180
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-3219
Mailing Address - Country:US
Mailing Address - Phone:239-319-5353
Mailing Address - Fax:
Practice Address - Street 1:28410 BONITA CROSSINGS BLVD UNIT 180
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-3219
Practice Address - Country:US
Practice Address - Phone:239-319-5353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-14
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM3000XAmbulatory Health Care FacilitiesClinic/CenterMedically Fragile Infants and Children Day Care