Healthcare Provider Details

I. General information

NPI: 1336902386
Provider Name (Legal Business Name): PSYCHE HARMONY GROUP, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2024
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 PONCE DE LEON BLVD STE 1240
CORAL GABLES FL
33134-5215
US

IV. Provider business mailing address

2100 PONCE DE LEON BLVD STE 1240
CORAL GABLES FL
33134-5215
US

V. Phone/Fax

Practice location:
  • Phone: 305-987-1007
  • Fax:
Mailing address:
  • Phone: 305-987-1007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MANUEL D. GONZALEZ
Title or Position: MD
Credential:
Phone: 305-987-1007