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General NPI Number Information
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NPI Number | 1679366678
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Entity Type | Organization
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Legal Business Name | UR MENTAL WELLNESS PLLC
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Dates
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Enumeration Date | 05/23/2025
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Last Update Date | 05/23/2025
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Provider Practice Location Address
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Address Line | 9994 SW 31ST TER
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City | MIAMI
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State | FL
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Zip | 33165-2961
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Country | US
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Telephone | 786-977-8817
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Fax | 786-590-1096
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Provider Business Mailing Address
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Address Line | 1421 SW 107TH AVE # 200
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City | MIAMI
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State | FL
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Zip | 33174-2526
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Country | US
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Telephone | 786-977-8817
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DIEGO BUSTILLO
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Credential | RN
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Telephone | 808-348-4385
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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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