Healthcare Provider Details

I. General information

NPI: 1053064675
Provider Name (Legal Business Name): MENTALLY PSYCHIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2022
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10689 N KENDALL DR STE 211
MIAMI FL
33176-1594
US

IV. Provider business mailing address

10689 N KENDALL DR STE 211
MIAMI FL
33176-1594
US

V. Phone/Fax

Practice location:
  • Phone: 305-204-9499
  • Fax: 507-607-8720
Mailing address:
  • Phone: 305-204-9499
  • Fax: 507-607-8720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSE GABRIEL VALDES
Title or Position: CEO
Credential: DNP, APRN, PMHNP-BC
Phone: 786-208-0065