Healthcare Provider Details

I. General information

NPI: 1306897954
Provider Name (Legal Business Name): OUTPATIENT PSY CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 07/02/2024
Certification Date: 07/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3271 NW 7TH ST. SUITE # 203
MIAMI FL
33125
US

IV. Provider business mailing address

PO BOX 347604
CORAL GABLES FL
33234-7604
US

V. Phone/Fax

Practice location:
  • Phone: 786-220-6902
  • Fax: 866-726-0526
Mailing address:
  • Phone: 305-984-8422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY5395
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY5395
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. VIVIAN D.J. GONZALEZ-DIAZ
Title or Position: PRESIDENT
Credential: PH.D
Phone: 786-220-6902