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General NPI Number Information
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NPI Number | 1154932457
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Entity Type | Organization
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Legal Business Name | MENTAL CARE MEDICAL CENTER INC
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Dates
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Enumeration Date | 08/11/2020
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Last Update Date | 06/26/2023
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Provider Practice Location Address
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Address Line | 7925 NW 12TH ST STE 225
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City | DORAL
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State | FL
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Zip | 33126-1821
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Country | US
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Telephone | 305-788-6644
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Fax |
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Provider Business Mailing Address
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Address Line | 7925 NW 12TH ST STE 225
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City | DORAL
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State | FL
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Zip | 33126-1821
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Country | US
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Telephone | 305-788-6644
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | PEDRO A AMADOR RODRIGUEZ
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Credential |
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Telephone | 305-788-6644
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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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 | 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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Taxonomy #3
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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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