Provider Demographics
NPI:1912275488
Name:FLORIDA INSTITUTE OF PEDIATRICS
Entity Type:Organization
Organization Name:FLORIDA INSTITUTE OF PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:NAZLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-360-2465
Mailing Address - Street 1:8765 SW 165TH AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-5831
Mailing Address - Country:US
Mailing Address - Phone:786-360-2465
Mailing Address - Fax:786-360-2966
Practice Address - Street 1:8765 SW 165TH AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-5831
Practice Address - Country:US
Practice Address - Phone:786-360-2465
Practice Address - Fax:786-360-2966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90107208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty