Provider Demographics
NPI:1104068113
Name:PEDROSO PEDIATRICS PA
Entity type:Organization
Organization Name:PEDROSO PEDIATRICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PEDROSO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-923-9494
Mailing Address - Street 1:2647 HOLLYWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-4840
Mailing Address - Country:US
Mailing Address - Phone:954-923-9494
Mailing Address - Fax:954-923-2887
Practice Address - Street 1:2647 HOLLYWOOD BLVD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-4840
Practice Address - Country:US
Practice Address - Phone:954-923-9494
Practice Address - Fax:877-286-3853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-06
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME73710208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty