Organization
CHILDRENS DIAGNOSTIC & TREATMENT CENTER INC
Active
Other names
EIP Professional
Organization subpart
No
Provider details
NPI number
Authorized official
ANA CALDERON RANDAZZO PHD (ADMINISTRATOR)
(954) 728-1060
Entity
Organization
Contact information
Practice address
1401 S FEDERAL HWY, FORT LAUDERDALE, FL 33316-2619
(954) 728-8080
(954) 779-1957
Mailing address
1700 NW 49TH ST STE 125, FORT LAUDERDALE, FL 33309-3750
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
208000000X
Pediatrics Physician
—
—
224Z00000X
Occupational Therapy Assistant
—
—
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
2355A2700X
Audiology Assistant
—
—
235Z00000X
Speech-Language Pathologist
—
—
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
055049302
—
FL
01
—
34478
BCBS
FL
Enumeration date
04/17/2007
Last updated
04/01/2024
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