| NPI | 1962108597 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MERCEDES DERICHO Owner 786-389-9773 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 251S00000X |
| 261Q00000X Clinic/Center | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| 261QP2000X Clinic/Center, Physical Therapy | |
| Enumeration Date | 2023-02-06 |
| Last Update Date | 2023-02-10 |