Healthcare Provider Details

I. General information

NPI: 1366460396
Provider Name (Legal Business Name): COMPREHENSIVE COMMUNITY GUIDANCE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 NW 29STREET
MIAMI FL
33127
US

IV. Provider business mailing address

160 NW 29TH ST
MIAMI FL
33127-3930
US

V. Phone/Fax

Practice location:
  • Phone: 305-576-0231
  • Fax: 305-573-1458
Mailing address:
  • Phone: 305-576-0231
  • Fax: 305-573-1458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. REYNALDO CRUZ
Title or Position: CEO
Credential:
Phone: 305-576-0231