Healthcare Provider Details

I. General information

NPI: 1417803016
Provider Name (Legal Business Name): SOAR COMMUNITY MENTAL HEALTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2026
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4160 W 16TH AVE STE 405
HIALEAH FL
33012-5853
US

IV. Provider business mailing address

4160 W 16TH AVE STE 405
HIALEAH FL
33012-5853
US

V. Phone/Fax

Practice location:
  • Phone: 786-601-7909
  • Fax: 786-349-5647
Mailing address:
  • Phone: 786-601-7909
  • Fax: 786-349-5647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: ARIEL VAZQUEZ PEREZ
Title or Position: OWNER
Credential:
Phone: 786-601-7909