Healthcare Provider Details

I. General information

NPI: 1558095166
Provider Name (Legal Business Name): BEAUTIFUL MINDS HEALTH CARE FACILITIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2022
Last Update Date: 08/08/2022
Certification Date: 08/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10912 SW 184TH ST
CUTLER BAY FL
33157-6608
US

IV. Provider business mailing address

23846 SW 116TH CT
HOMESTEAD FL
33032-7188
US

V. Phone/Fax

Practice location:
  • Phone: 305-647-9499
  • Fax:
Mailing address:
  • Phone: 305-647-9499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GABRIELA MARINELLO
Title or Position: SITE DIRECTOR
Credential:
Phone: 305-647-9499