Healthcare Provider Details

I. General information

NPI: 1144159237
Provider Name (Legal Business Name): PRESTIGIOUS MENTAL & WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6405 NW 36TH ST STE 117
VIRGINIA GARDENS FL
33166-6977
US

IV. Provider business mailing address

6405 NW 36TH ST STE 117
VIRGINIA GARDENS FL
33166-6977
US

V. Phone/Fax

Practice location:
  • Phone: 305-497-2473
  • Fax: 213-426-5183
Mailing address:
  • Phone: 305-497-2473
  • Fax: 213-426-5183

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: JESENIA VALDES
Title or Position: OWNER
Credential:
Phone: 305-497-2473