Provider Demographics
NPI:1972485662
Name:NICKLAUS CHILDREN'S PEDIATRIC SPECIALISTS, LLC
Entity type:Organization
Organization Name:NICKLAUS CHILDREN'S PEDIATRIC SPECIALISTS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SVP/CCOO
Authorized Official - Prefix:
Authorized Official - First Name:MARCOS
Authorized Official - Middle Name:
Authorized Official - Last Name:MESTRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-666-6511
Mailing Address - Street 1:3100 SW 62ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-3009
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1625 SE 3RD AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2521
Practice Address - Country:US
Practice Address - Phone:305-666-6511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NICKLAUS CHILDREN'S PEDIATRIC SPECIALISTS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-07-23
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric GastroenterologyGroup - Multi-Specialty
No2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric EndocrinologyGroup - Multi-Specialty
No2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Multi-Specialty