| NPI | 1316523640 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | YUSELIS TITO AMADOR Authorized Official 305-497-0977 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2021-03-18 |
| Last Update Date | 2025-11-18 |