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General NPI Number Information
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NPI Number | 1073192258
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Entity Type | Organization
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Legal Business Name | LAGO MENTAL HEALTH CORP
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Dates
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Enumeration Date | 04/06/2021
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Last Update Date | 03/11/2025
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Provider Practice Location Address
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Address Line | 11055 SW 186TH ST STE 207
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City | CUTLER BAY
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State | FL
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Zip | 33157-6842
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Country | US
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Telephone | 786-692-5743
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Fax | 786-422-9043
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Provider Business Mailing Address
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Address Line | 11055 SW 186TH ST STE 207
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City | CUTLER BAY
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State | FL
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Zip | 33157-6842
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Country | US
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Telephone | 786-483-5523
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICAL
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Name | MR. ADLAY LAGO
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Credential |
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Telephone | 786-483-5523
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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