Healthcare Provider Details

I. General information

NPI: 1942667423
Provider Name (Legal Business Name): PRESTIGE MEDICAL SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2016
Last Update Date: 11/14/2022
Certification Date: 05/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13701 SW 88TH ST STE 305
MIAMI FL
33186-1309
US

IV. Provider business mailing address

4662 N.W. 107 AVENUE #1903
MIAMI FL
33178
US

V. Phone/Fax

Practice location:
  • Phone: 786-703-6218
  • Fax:
Mailing address:
  • Phone: 786-703-6218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: ANNIE BOUCHEREAU
Title or Position: PRESIDENT
Credential:
Phone: 954-925-3844