Healthcare Provider Details

I. General information

NPI: 1225748031
Provider Name (Legal Business Name): SAPPHIRE MENTAL HEALTH CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2022
Last Update Date: 02/24/2023
Certification Date: 02/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10250 SW 56TH ST STE C202
MIAMI FL
33165-7098
US

IV. Provider business mailing address

10250 SW 56TH ST STE C202
MIAMI FL
33165-7098
US

V. Phone/Fax

Practice location:
  • Phone: 754-816-5001
  • Fax: 754-816-5208
Mailing address:
  • Phone: 754-816-5001
  • Fax: 754-816-5208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANA TERESA DEL PINO
Title or Position: PRESIDENT
Credential:
Phone: 754-816-5001