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General NPI Number Information
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NPI Number | 1144602681
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Entity Type | Organization
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Legal Business Name | THE FENIX HEALTH GROUP, INC
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Dates
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Enumeration Date | 06/21/2015
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Last Update Date | 11/20/2015
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Provider Practice Location Address
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Address Line | 721 NW 29TH ST
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City | MIAMI
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State | FL
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Zip | 33127-3828
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Country | US
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Telephone | 786-487-4535
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Fax |
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Provider Business Mailing Address
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Address Line | 721 NW 29TH ST
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City | MIAMI
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State | FL
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Zip | 33127-3828
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Country | US
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Telephone | 786-487-4535
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. JENNIFER JOHN CARBON
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Credential |
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Telephone | 786-487-4535
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084A0401X
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Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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