Organization Active NPI

Miami Lakes Pediatrics PLLC

  • Pediatrics Physician
  • Loxahatchee, FL
National Provider Identifier
1366030835
Registry record updated Jan 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
MIAMI LAKES PEDIATRICS PLLC
Practice address
12957 Palms West Dr Ste 101
Loxahatchee, FL 33470-4932
Phone
(561) 795-5979
Fax
(561) 795-9460
NPI assigned
Jan 9, 2021
Organization subpart
Yes
Parent organization
MIAMI LAKES PEDIATRICS PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 9, 2021

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

Authorized official

Name
Cristina Alfonso
Title
Practice Administrator
Phone
(305) 823-7768

Specialties & licenses 1

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

Addresses

Primary practice location

12957 Palms West Dr Ste 101
Loxahatchee, FL 33470-4932

Mailing address

14400 NW 77TH CT Ste 102
Miami Lakes, FL 33016-1590
Phone (305) 823-7768

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
10D0669944Miami Lakes Pediatrics PLLC12957 Palms West Dr - Ste 101, Loxahatchee, FL 33470Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
Miami Lakes Pediatrics PLLC3 organizations share this tax ID, including this one
Part of
Miami Lakes Pediatrics PLLC

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1610150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1610150400000",
    "number": "1366030835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14400 NW 77TH CT STE 102",
            "city": "MIAMI LAKES",
            "state": "FL",
            "postal_code": "330161590",
            "telephone_number": "305-823-7768",
            "fax_number": "305-823-2211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12957 PALMS WEST DR STE 101",
            "city": "LOXAHATCHEE",
            "state": "FL",
            "postal_code": "334704932",
            "telephone_number": "561-795-5979",
            "fax_number": "561-795-9460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIAMI LAKES PEDIATRICS PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MIAMI LAKES PEDIATRICS PLLC",
        "enumeration_date": "2021-01-09",
        "last_updated": "2021-01-09",
        "certification_date": "2021-01-09",
        "status": "A",
        "authorized_official_last_name": "ALFONSO",
        "authorized_official_first_name": "CRISTINA",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "305-823-7768"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Loxahatchee, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2021; 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.