| NPI | 1104457977 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | YONAIKA LARA Owner 813-415-2982 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty |
| Additional Taxonomies | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2020-01-30 |
| Last Update Date | 2020-02-07 |