Healthcare Provider Details

I. General information

NPI: 1871108308
Provider Name (Legal Business Name): MRS PSYCHIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2020
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 W 49TH ST STE 512
HIALEAH FL
33012-3488
US

IV. Provider business mailing address

52 S ROYAL POINCIANA BLVD
MIAMI SPRINGS FL
33166-6059
US

V. Phone/Fax

Practice location:
  • Phone: 305-200-7681
  • Fax: 305-847-2447
Mailing address:
  • Phone: 305-200-7681
  • Fax: 305-847-2447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. MAYTE SOLANGE RUIZ SANTIAGO
Title or Position: OWNER
Credential: MD
Phone: 786-536-1701