Organization
CORAL RIDGE PEDIATRICS INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEPHEN DIETZ (OFFICE MANAGER)
(212) 414-8297
Entity
Organization
Contact information
Practice address
915 MIDDLE RIVER DR STE 209, FORT LAUDERDALE, FL 33304-3559
(954) 300-1736
Mailing address
915 MIDDLE RIVER DR STE 209, FORT LAUDERDALE, FL 33304-3559
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Enumeration date
09/23/2021
Last updated
09/23/2021
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