Provider Demographics
NPI:1013116292
Name:KID CARE PEDIATRICS, P A
Entity Type:Organization
Organization Name:KID CARE PEDIATRICS, P A
Other - Org Name:KID CARE PEDIATRICS, P A
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:VICTORIA
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-821-1600
Mailing Address - Street 1:801A W 48TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3541
Mailing Address - Country:US
Mailing Address - Phone:305-821-1600
Mailing Address - Fax:305-821-1632
Practice Address - Street 1:801A W 48TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3541
Practice Address - Country:US
Practice Address - Phone:305-821-1600
Practice Address - Fax:305-821-1632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty