Healthcare Provider Details

I. General information

NPI: 1053860114
Provider Name (Legal Business Name): TERI ROBIOU LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2016
Last Update Date: 04/21/2021
Certification Date: 04/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 MADRUGA AVE STE 300
CORAL GABLES FL
33146-3164
US

IV. Provider business mailing address

1450 MADRUGA AVE STE 300
CORAL GABLES FL
33146-3164
US

V. Phone/Fax

Practice location:
  • Phone: 305-788-9928
  • Fax:
Mailing address:
  • Phone: 305-788-9928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberPY8108
License Number StateFL

VIII. Authorized Official

Name: TERI ROBIOU
Title or Position: OWNER
Credential: PH.D.
Phone: 305-788-9928