Provider Demographics
NPI:1538974837
Name:NICKLAUS CHILDREN'S PEDIATRIC SPECIALISTS, LLC
Entity type:Organization
Organization Name:NICKLAUS CHILDREN'S PEDIATRIC SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SVP
Authorized Official - Prefix:
Authorized Official - First Name:MARCOS
Authorized Official - Middle Name:
Authorized Official - Last Name:MESTRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-666-6511
Mailing Address - Street 1:PO BOX 947095
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30394-7095
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6262 SUNSET DR STE 500
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4843
Practice Address - Country:US
Practice Address - Phone:305-669-6503
Practice Address - Fax:305-668-8045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty