Provider Demographics
NPI:1205648102
Name:NICKLAUS CHILDREN'S HOSPITAL
Entity type:Organization
Organization Name:NICKLAUS CHILDREN'S HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:POSTDOCTORAL PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:
Authorized Official - Last Name:AREVALO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-418-7771
Mailing Address - Street 1:3601 NW 107TH AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-4377
Mailing Address - Country:US
Mailing Address - Phone:305-418-7771
Mailing Address - Fax:
Practice Address - Street 1:3601 NW 107TH AVE FL 3
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-4377
Practice Address - Country:US
Practice Address - Phone:305-418-7771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty