Provider Demographics
NPI:1184884918
Name:KOOL KIDZ PEDIATRICS
Entity type:Organization
Organization Name:KOOL KIDZ PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORENO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-433-1966
Mailing Address - Street 1:1951 SW 172ND AVE
Mailing Address - Street 2:SUITE 410
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33029-5593
Mailing Address - Country:US
Mailing Address - Phone:954-433-1966
Mailing Address - Fax:954-433-3466
Practice Address - Street 1:1951 SW 172ND AVE
Practice Address - Street 2:SUITE 410
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33029-5593
Practice Address - Country:US
Practice Address - Phone:954-433-1966
Practice Address - Fax:954-433-3466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME73747261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254343OtherAVMED
FL274336100Medicaid
FL42955OtherBCBS
FL537102OtherCIGNA
FL53941OtherJMH
FL253373100Medicaid
FL053586OtherNHP
FL207345OtherAMERIGROUP