| NPI | 1790406106 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GABRIEL DIETSCH Owner 786-698-5808 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 261QH0100X Clinic/Center Health Service |
| 261QI0500X Clinic/Center Infusion Therapy | |
| 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) | |
| 261QM0850X Clinic/Center Adult Mental Health | |
| 261QP2300X Clinic/Center Primary Care | |
| 261QR1100X Clinic/Center Research | |
| Enumeration Date | 2022-09-06 |
| Last Update Date | 2022-09-06 |