MEDICARE: MIND LIBERTY CENTER INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1300X	Multi-Specialty Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275118986
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIND LIBERTY CENTER INC

Provider Business Mailing Address
First Line	:	2190 NW 2ND ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33125-5326
Country	:	US
Telephone Number	:	305-876-6463
Fax Number	:	786-744-6463

Provider Business Practice Location Address
First Line	:	2190 NW 2ND ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33125-5326
Country	:	US
Telephone Number	:	305-876-6463
Fax Number	:	786-744-6463

Authorized Official
Title or Position	:	PRESIDENT
Name	:	FRANCISCO TORRES
Credential	:
Telephone Number	:	305-876-6463

Provider Enumeration Date	:	03/15/2021
Last Update Date	:	12/19/2022

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Directions to “MIND LIBERTY CENTER INC ” Practice Location

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