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General NPI Number Information
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NPI Number | 1063170124
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Entity Type | Organization
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Legal Business Name | MINDFUL MEDICINE LLC
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Dates
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Enumeration Date | 12/06/2021
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Last Update Date | 12/12/2022
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Provider Practice Location Address
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Address Line | 7000 W PALMETTO PARK RD STE 406
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City | BOCA RATON
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State | FL
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Zip | 33433-3425
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Country | US
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Telephone | 844-986-4325
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Fax |
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Provider Business Mailing Address
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Address Line | 7000 W PALMETTO PARK RD STE 406
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City | BOCA RATON
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State | FL
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Zip | 33433-3425
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Country | US
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Telephone | 844-986-4325
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Fax |
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Authorized Official
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Title or Position | CEO/ MEDICAL DIRECTOR
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Name | DR. BARRY DAVID PESKIN
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Credential | MD
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Telephone | 216-973-2844
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number |
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License Number State |
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