Healthcare Provider Details

I. General information

NPI: 1669259537
Provider Name (Legal Business Name): PSYCHIATRIC EQUILIBRIUM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2023
Last Update Date: 10/24/2023
Certification Date: 10/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6141 SUNSET DR STE 130A
SOUTH MIAMI FL
33143-5028
US

IV. Provider business mailing address

6141 SUNSET DR STE 130A
SOUTH MIAMI FL
33143-5028
US

V. Phone/Fax

Practice location:
  • Phone: 786-318-6822
  • Fax:
Mailing address:
  • Phone: 786-318-6822
  • Fax:

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
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KENIA MONTERO
Title or Position: PRESIDENT
Credential: APRN
Phone: 786-318-6822