Provider Demographics
NPI:1023587185
Name:INNOVATIVE PEDIATRIC LEARNING CENTER OF MIAMI
Entity type:Organization
Organization Name:INNOVATIVE PEDIATRIC LEARNING CENTER OF MIAMI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:DARLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-306-9955
Mailing Address - Street 1:2780 S DOUGLAS RD STE 203
Mailing Address - Street 2:
Mailing Address - City:COCONUT GROVE
Mailing Address - State:FL
Mailing Address - Zip Code:33133-2740
Mailing Address - Country:US
Mailing Address - Phone:786-622-2353
Mailing Address - Fax:
Practice Address - Street 1:2780 S DOUGLAS RD STE 203
Practice Address - Street 2:
Practice Address - City:COCONUT GROVE
Practice Address - State:FL
Practice Address - Zip Code:33133-2740
Practice Address - Country:US
Practice Address - Phone:786-622-2353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-19
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty