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General NPI Number Information
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NPI Number | 1528610136
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Entity Type | Organization
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Legal Business Name | BRIGHTSTAR COMMUNITY MENTAL CORP
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Dates
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Enumeration Date | 07/13/2019
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Last Update Date | 07/12/2025
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Provider Practice Location Address
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Address Line | 3970 W FLAGLER ST STE 102
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City | CORAL GABLES
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State | FL
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Zip | 33134-1642
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Country | US
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Telephone | 786-266-0956
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Fax |
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Provider Business Mailing Address
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Address Line | 3970 W FLAGLER ST STE 102
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City | CORAL GABLES
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State | FL
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Zip | 33134-1642
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Country | US
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Telephone | 786-317-0336
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JORGE L MANSO
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Credential |
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Telephone | 786-317-0336
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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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 | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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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 | 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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