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General NPI Number Information
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NPI Number | 1598552143
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Entity Type | Organization
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Legal Business Name | MINDTRA LLC
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Dates
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Enumeration Date | 04/24/2025
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Last Update Date | 04/24/2025
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Provider Practice Location Address
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Address Line | 44 NW 17TH ST
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City | HOMESTEAD
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State | FL
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Zip | 33030-3211
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Country | US
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Telephone | 305-209-4750
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Fax | 305-824-8803
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Provider Business Mailing Address
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Address Line | 44 NW 17TH ST
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City | HOMESTEAD
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State | FL
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Zip | 33030-3211
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Country | US
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Telephone | 305-209-4750
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Fax | 305-824-8803
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MARY A GARCIA
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Credential | SMHNP
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Telephone | 786-246-6150
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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