Healthcare Provider Details

I. General information

NPI: 1386985745
Provider Name (Legal Business Name): AXIS NEUROPSYCHOLOGICAL SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2013
Last Update Date: 03/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MIRACLE MILE
CORAL GABLES FL
33134-5430
US

IV. Provider business mailing address

372 WHITETHORN DR
MIAMI SPRINGS FL
33166-4952
US

V. Phone/Fax

Practice location:
  • Phone: 305-445-3222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberPY8702
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License NumberPY8702
License Number StateFL

VIII. Authorized Official

Name: DR. GINA PATRICIA SALCEDO-SAMPER
Title or Position: PRESIDENT
Credential: PSY.D.
Phone: 786-260-4212