NPIMap

Organization Active NPI

Nicklaus Children's Pediatric Specialists, LLC

Doing business as Nicklaus Children's at Pembroke Pines

  • Pediatrics Physician
  • Pembroke Pines, FL
National Provider Identifier
1073219309
Registry record updated Nov 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
NICKLAUS CHILDREN'S PEDIATRIC SPECIALISTS, LLC
Doing business as
Nicklaus Children's at Pembroke Pines
Practice address
208 N University Dr
Pembroke Pines, FL 33024-6716
Phone
(954) 432-3888
NPI assigned
Feb 7, 2023
Last updated
Nov 6, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2024

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

Authorized official

Name
Marcos Mestre
Title
SVP
Phone
(305) 666-6511

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

208 N University Dr
Pembroke Pines, FL 33024-6716

Mailing address

PO Box 947095
Atlanta, GA 30394-7095

Other names 1

  • Nicklaus Children's at Pembroke Pines Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D0723277Nicklaus Children's Pediatric Specialists, LLC208 N University Dr, Pembroke Pines, FL 33024Certificate of waiverNov 3, 2027

National Provider Directory

National Provider Directory
Tax ID family
Nicklaus Children's Pediatric Specialists LLC76 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 20

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1675728000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730851200000",
    "number": "1073219309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 947095",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303947095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "208 N UNIVERSITY DR",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330246716",
            "telephone_number": "954-432-3888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NICKLAUS CHILDREN'S PEDIATRIC SPECIALISTS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-07",
        "last_updated": "2024-11-06",
        "certification_date": "2024-11-06",
        "status": "A",
        "authorized_official_last_name": "MESTRE",
        "authorized_official_first_name": "MARCOS",
        "authorized_official_title_or_position": "SVP",
        "authorized_official_telephone_number": "305-666-6511"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Nicklaus Children's at Pembroke Pines",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pembroke Pines, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.