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General NPI Number Information
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NPI Number | 1932881992
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Entity Type | Organization
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Legal Business Name | OPTIMUS MENTAL HEALTH LLC
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Dates
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Enumeration Date | 08/01/2023
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Last Update Date | 08/01/2023
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Provider Practice Location Address
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Address Line | 306 ALCAZAR AVE STE 205
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City | CORAL GABLES
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State | FL
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Zip | 33134-4331
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Country | US
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Telephone | 305-967-8725
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Fax | 305-967-8446
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Provider Business Mailing Address
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Address Line | 306 ALCAZAR AVE STE 205
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City | CORAL GABLES
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State | FL
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Zip | 33134-4331
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Country | US
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Telephone | 305-967-8725
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Fax | 305-967-8446
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Authorized Official
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Title or Position | OWNER
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Name | MARIETA MANRESA
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Credential | PHD
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Telephone | 786-354-3505
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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