Healthcare Provider Details

I. General information

NPI: 1093272296
Provider Name (Legal Business Name): SOCIAL ADVANCE CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2019
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 W PALM DR STE D
FLORIDA CITY FL
33034-3237
US

IV. Provider business mailing address

640 W PALM DR STE D
FLORIDA CITY FL
33034-3237
US

V. Phone/Fax

Practice location:
  • Phone: 786-610-8167
  • Fax:
Mailing address:
  • Phone: 786-610-8167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ANNIA M PEREZ
Title or Position: PRESIDENT
Credential: CBHCMS
Phone: 786-610-8167