Active NPI
Mariza Souza Petrick, MD
- Pediatrics Physician
- Hialeah, FL
National Provider Identifier
1194779959
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- ME0054500
- Practice address
- 440 W 49TH St
Hialeah, FL 33012-3603 - Phone
- (305) 828-5700
- Fax
- (305) 461-5911
- NPI assigned
- May 19, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | ME0054500 | FL | Primary |
Addresses
Primary practice location
440 W 49TH St
Hialeah, FL 33012-3603
Mailing address
4960 SW 72ND Ave
Suite 406
Miami, FL 33155-5544
Phone (305) 662-5200
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| ME0054500 | Other | FL | MEDICAL LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME0054500 | FL | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147996800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1194779959",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4960 SW 72ND AVE",
"address_2": "SUITE 406",
"city": "MIAMI",
"state": "FL",
"postal_code": "331555544",
"telephone_number": "305-662-5200",
"fax_number": "305-284-7948"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "440 W 49TH ST",
"city": "HIALEAH",
"state": "FL",
"postal_code": "330123603",
"telephone_number": "305-828-5700",
"fax_number": "305-461-5911"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETRICK",
"first_name": "MARIZA",
"middle_name": "SOUZA",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-19",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "FL",
"license": "ME0054500",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAL LICENSE",
"identifier": "ME0054500",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hialeah, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.