Organization
EVOLVE PEDIATRIC PPEC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. VICTOR M PENA (AUTHORIZED OFFICIAL)
(786) 443-9749
Entity
Organization
Contact information
Practice address
15273 SW 28TH TER, MIAMI, FL 33185-5673
(786) 443-9749
(786) 353-2757
Mailing address
15273 SW 28TH TER, MIAMI, FL 33185-5673
(786) 443-9749
(786) 353-2757
Taxonomy
Speciality
Code
Description
License number
State
261QM3000X
Medically Fragile Infants and Children Day Care
Primary
—
—
Other
Enumeration date
06/09/2021
Last updated
06/09/2021
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