Healthcare Provider Details

I. General information

NPI: 1265871842
Provider Name (Legal Business Name): THE MONARCH COLLECTIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2013
Last Update Date: 06/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5810 BISCAYNE BLVD
MIAMI FL
33137-2639
US

IV. Provider business mailing address

5810 BISCAYNE BLVD
MIAMI FL
33137-2639
US

V. Phone/Fax

Practice location:
  • Phone: 786-953-6417
  • Fax: 305-938-5093
Mailing address:
  • Phone: 786-953-6417
  • Fax: 305-938-5093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State

VIII. Authorized Official

Name: TAMARA TAITT
Title or Position: OWNER
Credential:
Phone: 917-309-1618