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General NPI Number Information
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NPI Number | 1740702406
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Entity Type | Organization
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Legal Business Name | COMMUNITY MENTAL HEALTH AND WELLNESS CENTER OF DORAL INC
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Dates
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Enumeration Date | 07/13/2017
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Last Update Date | 03/27/2018
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Provider Practice Location Address
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Address Line | 9300 NW 25TH ST STE 106
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City | DORAL
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State | FL
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Zip | 33172-1506
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Country | US
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Telephone | 786-320-4603
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Fax |
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Provider Business Mailing Address
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Address Line | 9300 NW 25TH ST STE 106
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City | DORAL
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State | FL
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Zip | 33172-1506
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Country | US
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Telephone | 786-320-4603
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JESSICA RODRIGUEZ
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Credential |
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Telephone | 786-490-0974
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 102L00000X
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Taxonomy Name | Psychoanalyst
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License Number |
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License Number State |
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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 |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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