Healthcare Provider Details

I. General information

NPI: 1538566682
Provider Name (Legal Business Name): RAY OF LIGHT HEALTH CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2014
Last Update Date: 12/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12862 SW 55TH ST
MIAMI FL
33175-6214
US

IV. Provider business mailing address

12862 SW 55TH ST
MIAMI FL
33175-6214
US

V. Phone/Fax

Practice location:
  • Phone: 786-399-9946
  • Fax:
Mailing address:
  • Phone: 786-399-9946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License Number
License Number StateFL

VIII. Authorized Official

Name: DR. CARLOS ALBERTO PEREZ
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 786-399-9946