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General NPI Number Information
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NPI Number | 1851983993
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Entity Type | Organization
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Legal Business Name | RED ROAD CENTER OF SOUTH FLORIDA INC
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Dates
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Enumeration Date | 02/10/2021
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Last Update Date | 08/15/2023
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Provider Practice Location Address
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Address Line | 1350 SW 57TH AVE STE 315
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City | WEST MIAMI
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State | FL
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Zip | 33144-5774
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Country | US
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Telephone | 786-260-4727
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Fax |
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Provider Business Mailing Address
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Address Line | 1350 SW 57TH AVE STE 315
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City | WEST MIAMI
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State | FL
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Zip | 33144-5774
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARICELA GONZALEZ
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Credential |
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Telephone | 305-773-8173
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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