Healthcare Provider Details

I. General information

NPI: 1245885219
Provider Name (Legal Business Name): COMMUNITY CONNECTION FLORIDA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2019
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13155 SW 134TH ST STE 217
MIAMI FL
33186-4489
US

IV. Provider business mailing address

13155 SW 134TH ST STE 217
MIAMI FL
33186-4489
US

V. Phone/Fax

Practice location:
  • Phone: 786-652-9880
  • Fax: 786-652-9879
Mailing address:
  • Phone: 786-652-9880
  • Fax: 786-652-9879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 5
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: DIANA FINALES SUAREZ
Title or Position: OWNER
Credential:
Phone: 305-613-8827