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General NPI Number Information
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NPI Number | 1932470820
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Entity Type | Organization
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Legal Business Name | THERAPEUTIC ART CENTER
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Dates
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Enumeration Date | 01/24/2012
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Last Update Date | 01/24/2012
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Provider Practice Location Address
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Address Line | 1550 W 84TH ST STE 29
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City | HIALEAH
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State | FL
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Zip | 33014-3375
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Country | US
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Telephone | 786-222-9314
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Fax |
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Provider Business Mailing Address
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Address Line | 6333 W 24TH AVE APT 205
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City | HIALEAH
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State | FL
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Zip | 33016-6983
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Country | US
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Telephone | 786-222-9314
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | ABRAHAM VIDAL
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Credential |
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Telephone | 786-222-9314
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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