Healthcare Provider Details

I. General information

NPI: 1972117224
Provider Name (Legal Business Name): BEAUTIFUL MINDS MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2020
Last Update Date: 09/03/2020
Certification Date: 08/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11045 SW 216TH STREET UNIT 6
MIAMI FL
33170
US

IV. Provider business mailing address

23846 SW 116TH CT
HOMESTEAD FL
33032-7188
US

V. Phone/Fax

Practice location:
  • Phone: 305-647-9499
  • Fax:
Mailing address:
  • Phone: 305-647-9499
  • Fax: 305-508-6440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR1100X
TaxonomyResearch Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GABRIELA MARINELLO
Title or Position: DIRECTOR
Credential:
Phone: 305-647-9499