Healthcare Provider Details
I. General information
NPI: 1356987242
Provider Name (Legal Business Name): B.S.C. CARE PROVIDER CORP
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 11/26/2019
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:
III. Provider practice location address
9360 FONTAINEBLEAU BLVD APT D106
MIAMI FL
33172-5606
US
IV. Provider business mailing address
9360 FONTAINEBLEAU BLVD APT D106
MIAMI FL
33172-5606
US
V. Phone/Fax
- Phone: 305-562-6727
- Fax:
- Phone: 305-562-6727
- Fax: 305-402-8448
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 261QM0801X |
| Taxonomy | Mental Health Clinic/Center (Including Community Mental Health Center) |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LP0808X |
| Taxonomy | Psychiatric/Mental Health Nurse Practitioner |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
BARBARO
RAIMIS
SAROSA CEPERO
Title or Position: OWNER/CEO
Credential: APRN,FNP-C,PMHNP-BC.
Phone: 305-562-6727