Healthcare Provider Details

I. General information

NPI: 1881716355
Provider Name (Legal Business Name): EUSEBIO F DEL RIO M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1469 NW 36TH ST
MIAMI FL
33142-5557
US

IV. Provider business mailing address

384 NW 114TH AVE APT 109
MIAMI FL
33172-4774
US

V. Phone/Fax

Practice location:
  • Phone: 305-635-7444
  • Fax:
Mailing address:
  • Phone: 305-554-4258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH 5332
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: