Healthcare Provider Details

I. General information

NPI: 1851996722
Provider Name (Legal Business Name): ERIC PELEGRIN CALAFORRA LMHC, RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2020
Last Update Date: 12/04/2020
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 W 59TH PL
HIALEAH FL
33012-2307
US

IV. Provider business mailing address

1021 W 59TH PL
HIALEAH FL
33012-2307
US

V. Phone/Fax

Practice location:
  • Phone: 786-488-3235
  • Fax:
Mailing address:
  • Phone: 786-488-3235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9515994
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH16622
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: