Provider Demographics
NPI:1982977427
Name:VARIETY CHILDREN'S HOSPITAL
Entity type:Organization
Organization Name:VARIETY CHILDREN'S HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SR. PROVIDER RELATIONS SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:RAIZA
Authorized Official - Middle Name:BEATRIZ
Authorized Official - Last Name:VIDAURRAZAGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-624-2186
Mailing Address - Street 1:PO BOX 557367
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33255-7367
Mailing Address - Country:US
Mailing Address - Phone:786-624-5876
Mailing Address - Fax:786-624-2688
Practice Address - Street 1:3100 SW 62ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-3009
Practice Address - Country:US
Practice Address - Phone:305-666-6511
Practice Address - Fax:305-669-7123
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VARIETY CHILDREN'S HOPSITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-14
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010060900Medicaid
FL103301Medicare PIN