Organization
PEDIATRIC SPECIALTY GROUP, INC
Active
Parent organization
PEDIATRIC SPECIALTY GROUP, INC.
Other names
Pediatric Specialists of America At Palm City
Organization subpart
Yes
Provider details
NPI number
Legal business name
PEDIATRIC SPECIALTY GROUP, INC.
Authorized official
RAIZA BEATRIZ VIDAURRAZAGA (SR. PROVIDER RELATIONS SPECIALIST)
(786) 624-2186
Entity
Organization
Contact information
Practice address
3228 SW MARTIN DOWNS BLVD, PALM CITY, FL 34990-2679
(772) 286-8133
Mailing address
3100 SW 62ND AVE, MIAMI, FL 33155-3009
(772) 286-8133
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
2080I0007X
Pediatric Clinical & Laboratory Immunology Physician
—
—
2080P0202X
Pediatric Cardiology Physician
—
—
2080P0205X
Pediatric Endocrinology Physician
—
—
2080P0206X
Pediatric Gastroenterology Physician
—
—
Other
Enumeration date
01/31/2019
Last updated
01/31/2019
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