Prime Pediatric Associates, LLC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

ME109534 Issued in FL

Legal business name

PRIME PEDIATRIC ASSOCIATES, LLC

Practice address

100 E Sample Rd
Ste 120
Pompano Beach, FL 33064-3554

Phone

(954) 941-2021

Fax

(954) 941-2071

NPI assigned

Sep 17, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dibanni Vasquez, M.D.

Title

MGRM

Phone

(305) 972-1073

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1347840000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1347840000000",
    "number": "1023368164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 E SAMPLE RD",
            "address_2": "STE 120",
            "city": "POMPANO BEACH",
            "state": "FL",
            "postal_code": "330643554",
            "telephone_number": "954-941-2021",
            "fax_number": "954-941-2071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 E SAMPLE RD",
            "address_2": "STE 120",
            "city": "POMPANO BEACH",
            "state": "FL",
            "postal_code": "330643554",
            "telephone_number": "954-941-2021",
            "fax_number": "954-941-2071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME PEDIATRIC ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-17",
        "last_updated": "2012-09-17",
        "status": "A",
        "authorized_official_last_name": "VASQUEZ",
        "authorized_official_first_name": "DIBANNI",
        "authorized_official_title_or_position": "MGRM",
        "authorized_official_telephone_number": "305-972-1073",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME109534",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pediatrics Physician in Pompano Beach, FL
• Providers in Pompano Beach, FL by specialty
• Pediatrics Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.