| NPI | 1598187106 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHANNES LOPEZ Medical Director 305-383-2091 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251C00000X (Licence: FL ME78225) |
| Additional Taxonomies | 252Y00000X Early Intervention Provider Agency (Licence: FL ME78225) |
| 251S00000X Community/Behavioral Health (Licence: FL ME 78225) | |
| Enumeration Date | 2014-01-16 |
| Last Update Date | 2014-04-04 |