Healthcare Provider Details

I. General information

NPI: 1346087723
Provider Name (Legal Business Name): PRESTIGIOUS MENTAL WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2024
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 IVES DAIRY RD STE 216
MIAMI FL
33179-2537
US

IV. Provider business mailing address

PO BOX 5155
HIALEAH FL
33014-1155
US

V. Phone/Fax

Practice location:
  • Phone: 305-766-4064
  • Fax:
Mailing address:
  • Phone: 305-497-2473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number State

VIII. Authorized Official

Name: JESENIA VALDES
Title or Position: OWNER
Credential:
Phone: 305-497-2473