Healthcare Provider Details

I. General information

NPI: 1194506071
Provider Name (Legal Business Name): MEDICAL PRESTIGE SERVICES CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2023
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 DEL PRADO BLVD S STE 103
CAPE CORAL FL
33990-4557
US

IV. Provider business mailing address

2002 DEL PRADO BLVD S STE 103
CAPE CORAL FL
33990-4557
US

V. Phone/Fax

Practice location:
  • Phone: 239-244-2022
  • Fax: 239-402-2844
Mailing address:
  • Phone: 239-244-2022
  • Fax: 239-402-2844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: YANET HERNANDEZ
Title or Position: OWNER
Credential:
Phone: 305-733-1450