Basic Information
| Provider Information | |||||||||
| NPI: | 1598826406 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MIAMI PEDIATRIC HEMATOLOGY ONCOLOGY ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3100 SW 62ND AVE | ||||||||
| Address2: | SUITE 121 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331553009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056628360 | ||||||||
| FaxNumber: | 3056666387 | ||||||||
| Practice Location | |||||||||
| Address1: | 3100 SW 62ND AVE | ||||||||
| Address2: | SUITE 121 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331553009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056628360 | ||||||||
| FaxNumber: | 3056666387 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | ROCHA | ||||||||
| AuthorizedOfficialFirstName: | IVY | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3056638551 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0207X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Hematology-Oncology |
No ID Information.