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General NPI Number Information
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NPI Number | 1750029146
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Entity Type | Individual
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Provider Name | MIREL FELIBERTO NAVARRO GAMBOA CBHCM
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Gender | Male
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Dates
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Enumeration Date | 05/25/2022
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Last Update Date | 05/25/2022
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Provider Practice Location Address
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Address Line | 1905 NW 82ND AVE
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City | DORAL
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State | FL
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Zip | 33126-1011
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Country | US
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Telephone | 786-420-5924
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Fax | 786-542-5340
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Provider Business Mailing Address
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Address Line | 7379 NW 173RD DR APT 103
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City | HIALEAH
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State | FL
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Zip | 33015-8429
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Country | US
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Telephone | 786-865-0065
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | CBHCM103395
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License Number State |
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