Basic Information
| Provider Information | |||||||||
| NPI: | 1437733425 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHILDRENS DIAGNOSTIC & TREATMENT CENTER INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1700 NW 49TH ST STE 125 | ||||||||
| Address2: | |||||||||
| City: | FORT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333093750 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547288080 | ||||||||
| FaxNumber: | 9547791957 | ||||||||
| Practice Location | |||||||||
| Address1: | 5201 NW 33RD AVE | ||||||||
| Address2: | |||||||||
| City: | FORT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333096302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547288080 | ||||||||
| FaxNumber: | 9547791957 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2021 | ||||||||
| LastUpdateDate: | 05/06/2021 | ||||||||
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| AuthorizedOfficialLastName: | CALDERON RANDAZZO | ||||||||
| AuthorizedOfficialFirstName: | ANA | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 9547281060 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PHD | ||||||||
| NPICertificationDate: | 05/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
No ID Information.