Healthcare Provider Details

I. General information

NPI: 1669492062
Provider Name (Legal Business Name): REFLECTIONS WELLNESS CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 08/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5753 MIAMI LAKES DR E
MIAMI LAKES FL
33014-2417
US

IV. Provider business mailing address

5753 MIAMI LAKES DR E
MIAMI LAKES FL
33014-2417
US

V. Phone/Fax

Practice location:
  • Phone: 305-403-0006
  • Fax: 305-403-0007
Mailing address:
  • Phone: 305-403-0006
  • Fax: 305-403-0007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. LEONEL ERNESTO MESA JR.
Title or Position: CEO
Credential: PSYD
Phone: 305-403-0007