Provider Demographics
NPI:1437377702
Name:CHILDRENS GASTROENTEROLOGY OF SOUTH FLORIDA
Entity type:Organization
Organization Name:CHILDRENS GASTROENTEROLOGY OF SOUTH FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:A
Authorized Official - Last Name:GUERRERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-601-1599
Mailing Address - Street 1:12959 PALMS WEST DRIVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470
Mailing Address - Country:US
Mailing Address - Phone:561-795-3333
Mailing Address - Fax:561-791-3002
Practice Address - Street 1:12959 PALMS WEST DRIVE
Practice Address - Street 2:SUITE 210
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470
Practice Address - Country:US
Practice Address - Phone:561-795-3333
Practice Address - Fax:561-791-3002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME71612174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty