Healthcare Provider Details

I. General information

NPI: 1942923933
Provider Name (Legal Business Name): MEDICAL AND BEHAVIORAL HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2022
Last Update Date: 11/16/2023
Certification Date: 11/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8955 SW 87TH CT STE 212
MIAMI FL
33176-2223
US

IV. Provider business mailing address

8955 SW 87TH CT STE 212
MIAMI FL
33176-2223
US

V. Phone/Fax

Practice location:
  • Phone: 786-840-3454
  • Fax: 786-513-5923
Mailing address:
  • Phone: 786-840-3454
  • Fax: 786-513-5923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ONELIA FAJARDO
Title or Position: PRESIDENT
Credential:
Phone: 305-722-7210