Healthcare Provider Details

I. General information

NPI: 1558941906
Provider Name (Legal Business Name): BUENAVENTURA COMUNITY MENTAL HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2021
Last Update Date: 04/10/2021
Certification Date: 04/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 NW 107TH AVE STE 115
MIAMI FL
33172-3100
US

IV. Provider business mailing address

790 NW 107TH AVE STE 115
MIAMI FL
33172-3100
US

V. Phone/Fax

Practice location:
  • Phone: 786-270-6746
  • Fax:
Mailing address:
  • Phone: 786-270-6746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CAMILA PEREZ NUNEZ
Title or Position: CFO
Credential:
Phone: 786-270-6746