Healthcare Provider Details

I. General information

NPI: 1639031552
Provider Name (Legal Business Name): BRIGHT MIND INTEGRAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 11/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 SW 97TH PL
MIAMI FL
33165-7643
US

IV. Provider business mailing address

1710 SW 97TH PL
MIAMI FL
33165-7643
US

V. Phone/Fax

Practice location:
  • Phone: 305-917-5359
  • Fax:
Mailing address:
  • Phone: 305-917-5359
  • 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: ROBERTO PUGA
Title or Position: MGR
Credential: MSN, PMHNP, FNP
Phone: 305-917-5359