Organization
PEDIATRIC SPECIALTY GROUP, INC
Active
Other names
Nicklaus Children's Coconut Creek Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
RAIZA BEATRIZ VIDAURRAZAGA (SR. PROVIDER RELATIONS SPECIALIST)
(786) 624-2186
Entity
Organization
Contact information
Practice address
6370 N STATE ROAD 7 STE 100, COCONUT CREEK, FL 33073
(954) 321-7762
(954) 321-9596
Mailing address
3100 SW 62ND AVE, MIAMI, FL 33155-3009
(786) 624-5876
(786) 624-2688
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
—
—
207XP3100X
Pediatric Orthopaedic Surgery Physician
Primary
—
—
208000000X
Pediatrics Physician
—
—
2080P0201X
Pediatric Allergy/Immunology Physician
—
—
2080P0202X
Pediatric Cardiology Physician
—
—
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
—
—
2080P0205X
Pediatric Endocrinology Physician
—
—
2080P0206X
Pediatric Gastroenterology Physician
—
—
2080P0210X
Pediatric Nephrology Physician
—
—
2080P0216X
Pediatric Rheumatology Physician
—
—
208200000X
Plastic Surgery Physician
—
—
2085P0229X
Pediatric Radiology Physician
—
—
261QR0400X
Rehabilitation Clinic/Center
—
—
261QU0200X
Urgent Care Clinic/Center
—
—
282NC2000X
Children's Hospital
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010060900
—
FL
Enumeration date
05/15/2018
Last updated
09/26/2018
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