Healthcare Provider Details

I. General information

NPI: 1528610136
Provider Name (Legal Business Name): BRIGHTSTAR COMMUNITY MENTAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2019
Last Update Date: 07/12/2025
Certification Date: 07/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3970 W FLAGLER ST STE 102
CORAL GABLES FL
33134-1642
US

IV. Provider business mailing address

3970 W FLAGLER ST STE 102
CORAL GABLES FL
33134-1642
US

V. Phone/Fax

Practice location:
  • Phone: 786-266-0956
  • Fax:
Mailing address:
  • Phone: 786-317-0336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JORGE L MANSO
Title or Position: PRESIDENT
Credential:
Phone: 786-317-0336