Healthcare Provider Details

I. General information

NPI: 1679496442
Provider Name (Legal Business Name): MIAMI MENTAL HEALTH & WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 SW 148TH AVE STE 105
MIRAMAR FL
33027-3257
US

IV. Provider business mailing address

9835 SUNSET DR STE 105
MIAMI FL
33173-4648
US

V. Phone/Fax

Practice location:
  • Phone: 786-937-9835
  • Fax:
Mailing address:
  • Phone: 786-797-2051
  • Fax: 786-937-9834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ALEJANDRO DE LA PORTILLA
Title or Position: OWNER
Credential:
Phone: 786-797-2051