Provider Demographics
NPI:1336539303
Name:EZ-PEDIATRICS
Entity Type:Organization
Organization Name:EZ-PEDIATRICS
Other - Org Name:EZPEDS, PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ATTENDING PHYSICIAN/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:ZAMBRANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-431-8558
Mailing Address - Street 1:10794 PINES BLVD
Mailing Address - Street 2:STE 102
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-3920
Mailing Address - Country:US
Mailing Address - Phone:954-431-8558
Mailing Address - Fax:954-431-3867
Practice Address - Street 1:10794 PINES BLVD
Practice Address - Street 2:STE 102
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-3920
Practice Address - Country:US
Practice Address - Phone:954-431-8558
Practice Address - Fax:954-431-3867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-29
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME068860261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG151181OtherUPIN
FL1750832366OtherNPI
FL1336539303OtherGROUP NPI
FL1508815531OtherNPI
FL378700100Medicaid