Organization
CSI-PEDIATRIC SERVICES, LLC.
Active
Parent organization
PEDIATRIC HOLDINGS, LLC
Other names
Spark Pediatrics, CSI-SPECIAL CARE
Organization subpart
Yes
Provider details
NPI number
Legal business name
PEDIATRIC HOLDINGS, LLC
Authorized official
DONNA LODATO RN (CEO)
(786) 522-9600
Entity
Organization
Contact information
Practice address
1788 SE INDIAN ST, UNIT J, K, STUART, FL 34997-4919
(772) 247-1888
Mailing address
15050 NW 79TH CT STE 201, MIAMI LAKES, FL 33016-5810
(786) 522-9600
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
024133100
—
FL
Enumeration date
08/03/2016
Last updated
07/13/2022
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