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
10060 W MCNAB RD, TAMARAC, FL 33321-1894
(954) 947-3100
(954) 933-7576
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
—
101530900
—
FL
Enumeration date
02/23/2018
Last updated
07/13/2022
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