Healthcare Provider Details

I. General information

NPI: 1821758921
Provider Name (Legal Business Name): MINDLI HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2021
Last Update Date: 12/30/2021
Certification Date: 12/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 HOLLYWOOD BOULEVARD HILLS SUITE 517
HOLLYWOOD HILLS FL
33021
US

IV. Provider business mailing address

20211 NW 9TH DR
PEMBROKE PINES FL
33029-3427
US

V. Phone/Fax

Practice location:
  • Phone: 877-464-6354
  • Fax:
Mailing address:
  • Phone: 954-906-0601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JORGE A. SANTIAGO
Title or Position: ADMINISTRATOR
Credential:
Phone: 877-464-6354