=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427200989
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MENINOS CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/15/2008
-----------------------------------------------------
Last Update Date | 02/11/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 930 SW 82ND AVE SUITE B
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33144-4240
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-266-7301
-----------------------------------------------------
Fax | 305-266-7308
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 930 SW 82ND AVE SUITE B
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33144-4240
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-266-7301
-----------------------------------------------------
Fax | 305-266-7308
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP
-----------------------------------------------------
Name | MRS. MARGARITA LOURENCO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 786-399-8380
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number | ME39345
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------