Healthcare Provider Details

I. General information

NPI: 1154251148
Provider Name (Legal Business Name): AXIS MENTAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

965 W FLAGLER ST
MIAMI FL
33130-1139
US

IV. Provider business mailing address

4591 SW 151ST PL
MIAMI FL
33185-4365
US

V. Phone/Fax

Practice location:
  • Phone: 305-804-9624
  • Fax:
Mailing address:
  • Phone: 786-343-5161
  • Fax:

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: MARLON OSCAR RODRIGUEZ
Title or Position: CO FOUNDER
Credential: PMHNP
Phone: 305-804-9624