Healthcare Provider Details

I. General information

NPI: 1659100873
Provider Name (Legal Business Name): BLUE HEARTS ENTERPRISE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2024
Last Update Date: 07/26/2024
Certification Date: 07/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 BELVEDERE RD E-300 SUITE 17
WEST PALM BEACH FL
33406
US

IV. Provider business mailing address

1601 BELVEDERE RD E-300 SUITE 17
WEST PALM BEACH FL
33406
US

V. Phone/Fax

Practice location:
  • Phone: 786-532-0494
  • Fax:
Mailing address:
  • Phone: 786-532-0494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: BEATRIZ E RODRIGUEZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 561-889-9126