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General NPI Number Information
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NPI Number | 1013366830
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Entity Type | Organization
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Legal Business Name | PRODUCTIVE MINDS LLC
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Dates
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Enumeration Date | 06/13/2016
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Last Update Date | 06/13/2016
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Provider Practice Location Address
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Address Line | 6625 MIAMI LAKES DR
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City | MIAMI LAKES
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State | FL
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Zip | 33014-2708
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Country | US
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Telephone | 305-998-9806
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Fax |
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Provider Business Mailing Address
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Address Line | 5371 NW 190TH LN
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City | MIAMI GARDENS
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State | FL
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Zip | 33055-5323
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Country | US
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Telephone | 305-998-9806
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MELISSA MARIA SANTIAGO
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Credential |
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Telephone | 305-998-9806
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY9429
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License Number State | FL
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