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General NPI Number Information
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NPI Number | 1699937466
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Entity Type | Organization
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Legal Business Name | BEHAVIORAL MEDICINE & PSYCHOTHERAPY LLC
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Dates
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Enumeration Date | 07/01/2008
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Last Update Date | 06/06/2023
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Provider Practice Location Address
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Address Line | 2340 DAIRY RD SUITE 104
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City | MELBOURNE
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State | FL
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Zip | 32904-5246
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Country | US
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Telephone | 321-327-5952
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Fax | 321-327-5954
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Provider Business Mailing Address
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Address Line | 2401 W EAU GALLIE BLVD STE 1
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City | MELBOURNE
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State | FL
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Zip | 32935-2765
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Country | US
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Telephone | 321-327-5952
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Fax | 321-327-5954
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Authorized Official
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Title or Position | MANAGER
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Name | DR. LUIS MANUEL VINUELA
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Credential | MD
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Telephone | 321-704-3042
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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 | ME94555
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License Number State | FL
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