Healthcare Provider Details

I. General information

NPI: 1639890601
Provider Name (Legal Business Name): NURI ENRIQUE CHAVES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2022
Last Update Date: 09/08/2022
Certification Date: 09/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13390 W DIXIE HWY
NORTH MIAMI FL
33161-4135
US

IV. Provider business mailing address

1680 MERIDIAN AVE STE 501
MIAMI BEACH FL
33139-2719
US

V. Phone/Fax

Practice location:
  • Phone: 305-403-0654
  • Fax: 305-403-0653
Mailing address:
  • Phone: 305-531-5341
  • Fax: 305-532-5322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH18468
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: