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General NPI Number Information
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NPI Number | 1598712234
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Entity Type | Organization
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Legal Business Name | CENTER FOR SELF-DEVELOPMENT CORP
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Dates
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Enumeration Date | 05/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 18851 NE 29TH AV SUITE 700
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City | AVENTURA
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State | FL
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Zip | 33180-4049
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Country | US
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Telephone | 305-749-2500
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Fax | 305-749-2500
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Provider Business Mailing Address
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Address Line | 21205 YACHT CLUB DR # 3201
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City | AVENTURA
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State | FL
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Zip | 33180
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Country | US
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Telephone | 305-749-2500
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Fax | 305-749-2505
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. VIRGINIA MV BUKI
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Credential | MD
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Telephone | 305-749-2500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 185163
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME60240
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License Number State | FL
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