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General NPI Number Information
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NPI Number | 1063999449
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Entity Type | Organization
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Legal Business Name | FAMILY MENTAL HEALTH SERVICES LLC
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Dates
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Enumeration Date | 07/27/2018
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Last Update Date | 07/27/2018
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Provider Practice Location Address
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Address Line | 777 NW 72ND AVE STE 3019
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City | MIAMI
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State | FL
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Zip | 33126-3186
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Country | US
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Telephone | 305-529-4096
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Fax |
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Provider Business Mailing Address
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Address Line | 777 NW 72ND AVE STE 3019
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City | MIAMI
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State | FL
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Zip | 33126-3186
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Country | US
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Telephone | 305-529-4096
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Fax |
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Authorized Official
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Title or Position | AMBR
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Name | ROGELIO GONZALEZ
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Credential |
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Telephone | 786-728-1278
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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