Healthcare Provider Details

I. General information

NPI: 1851983993
Provider Name (Legal Business Name): RED ROAD CENTER OF SOUTH FLORIDA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2021
Last Update Date: 08/15/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 SW 57TH AVE STE 315
WEST MIAMI FL
33144-5774
US

IV. Provider business mailing address

1350 SW 57TH AVE STE 315
WEST MIAMI FL
33144-5774
US

V. Phone/Fax

Practice location:
  • Phone: 786-260-4727
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MARICELA GONZALEZ
Title or Position: OWNER
Credential:
Phone: 305-773-8173