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General NPI Number Information
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NPI Number | 1639031552
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Entity Type | Organization
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Legal Business Name | BRIGHT MIND INTEGRAL HEALTH, LLC
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Dates
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Enumeration Date | 12/01/2025
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 1710 SW 97TH PL
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City | MIAMI
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State | FL
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Zip | 33165-7643
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Country | US
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Telephone | 305-917-5359
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Fax |
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Provider Business Mailing Address
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Address Line | 1710 SW 97TH PL
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City | MIAMI
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State | FL
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Zip | 33165-7643
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Country | US
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Telephone | 305-917-5359
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Fax |
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Authorized Official
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Title or Position | MGR
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Name | ROBERTO PUGA
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Credential | MSN, PMHNP, FNP
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Telephone | 305-917-5359
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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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