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General NPI Number Information
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NPI Number | 1174021877
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Entity Type | Organization
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Legal Business Name | MENTIS GROUP LLC
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Dates
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Enumeration Date | 01/28/2018
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Last Update Date | 10/02/2018
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Provider Practice Location Address
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Address Line | 2700 SW 137TH AVE
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City | MIAMI
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State | FL
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Zip | 33175-6324
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Country | US
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Telephone | 305-586-2088
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Fax |
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Provider Business Mailing Address
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Address Line | 2700 SW 137TH AVE
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City | MIAMI
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State | FL
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Zip | 33175-6324
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Country | US
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Telephone | 305-586-2088
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Fax |
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Authorized Official
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Title or Position | MNGR
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Name | GISELLE IBANEZ
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Credential |
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Telephone | 305-586-2088
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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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