Healthcare Provider Details

I. General information

NPI: 1184388795
Provider Name (Legal Business Name): MIND-BODY OPTIMAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2021
Last Update Date: 10/29/2021
Certification Date: 10/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2321 RIVERDALE DR N
MIRAMAR FL
33025-3821
US

IV. Provider business mailing address

2321 RIVERDALE DR N
MIRAMAR FL
33025-3821
US

V. Phone/Fax

Practice location:
  • Phone: 305-215-1765
  • Fax:
Mailing address:
  • Phone: 305-215-1765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: PIERROT BADIO
Title or Position: PRESIDENT/MANAGER
Credential: APRN
Phone: 305-215-1765