MEDICARE: SPECTRUM MENTAL HEALTH CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1770438145
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECTRUM MENTAL HEALTH CORP

Provider Business Mailing Address
First Line	:	1901 W FLAGLER ST STE 7
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33135-1677
Country	:	US
Telephone Number	:	786-612-5973
Fax Number	:	786-592-4168

Provider Business Practice Location Address
First Line	:	1901 W FLAGLER ST STE 7
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33135-1677
Country	:	US
Telephone Number	:	786-612-5973
Fax Number	:	786-592-4168

Authorized Official
Title or Position	:	OWNER
Name	:	RAFAEL MARIO PRADO
Credential	:
Telephone Number	:	786-457-8256

Provider Enumeration Date	:	03/02/2026
Last Update Date	:	03/02/2026

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