Provider Demographics
NPI:1700185873
Name:SUNNY ISLES PEDIATRICS, PA
Entity Type:Organization
Organization Name:SUNNY ISLES PEDIATRICS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MIRIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTEVEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-230-6127
Mailing Address - Street 1:17395 N BAY RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SUNNY ISLES BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-3334
Mailing Address - Country:US
Mailing Address - Phone:786-230-6127
Mailing Address - Fax:305-825-2163
Practice Address - Street 1:17395 N BAY RD
Practice Address - Street 2:SUITE 203
Practice Address - City:SUNNY ISLES BEACH
Practice Address - State:FL
Practice Address - Zip Code:33160-3334
Practice Address - Country:US
Practice Address - Phone:786-230-6127
Practice Address - Fax:305-825-2163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-15
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79171261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL260364100Medicaid
FL260364100Medicaid