Healthcare Provider Details

I. General information

NPI: 1932944303
Provider Name (Legal Business Name): MED-PSY CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2024
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3271 NW 7TH ST STE 203
MIAMI FL
33125-4141
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:
Mailing address:
  • Phone: 786-220-6902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. VIVIAN DJ GONZALEZ-DIAZ
Title or Position: OWNER
Credential: PH.D
Phone: 305-984-8422