Healthcare Provider Details

I. General information

NPI: 1275760779
Provider Name (Legal Business Name): PALM PSYCHIATRIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2009
Last Update Date: 06/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10631 N KENDALL DR SUITE 125
MIAMI FL
33176-1568
US

IV. Provider business mailing address

10631 N KENDALL DR SUITE 125
MIAMI FL
33176-1568
US

V. Phone/Fax

Practice location:
  • Phone: 305-598-8000
  • Fax:
Mailing address:
  • Phone: 305-598-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License NumberME86541
License Number StateFL

VIII. Authorized Official

Name: DR. ELDA LOPEZ
Title or Position: OWNER/PRESIDENT
Credential: MD
Phone: 305-598-8000