Provider Demographics
NPI:1699984831
Name:ROYAL PALM KIDS CARE
Entity type:Organization
Organization Name:ROYAL PALM KIDS CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAGOBERTO
Authorized Official - Middle Name:J
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-752-8700
Mailing Address - Street 1:2825 N STATE ROAD 7
Mailing Address - Street 2:SUITE #305
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-5737
Mailing Address - Country:US
Mailing Address - Phone:954-752-8700
Mailing Address - Fax:954-752-0509
Practice Address - Street 1:2825 N STATE ROAD 7
Practice Address - Street 2:SUITE #305
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-5737
Practice Address - Country:US
Practice Address - Phone:954-752-8700
Practice Address - Fax:954-752-0509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0058463208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME0058463OtherLICENSE#
FL265743100Medicaid
FLBR2439568OtherDEA#
FLBR2439568OtherDEA#
FL265743100Medicaid