Healthcare Provider Details

I. General information

NPI: 1932706538
Provider Name (Legal Business Name): MANITISS MENTAL HEALTH INC DBA MEDICAL CENTER OF HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2020
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 SW 24TH ST STE 200
MIAMI FL
33165-2075
US

IV. Provider business mailing address

8900 SW 24TH ST STE 200
MIAMI FL
33165-2075
US

V. Phone/Fax

Practice location:
  • Phone: 305-640-8168
  • Fax: 305-967-8295
Mailing address:
  • Phone: 305-846-9775
  • Fax: 305-982-8637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ILDO CARMENATE
Title or Position: CEO
Credential:
Phone: 305-640-8168