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1905 Nw 82nd Ave Doral FL 33126-1011 | |
| (786) 420-5924 | |
| (786) 542-5340 |
| Full Name | |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1905 Nw 82nd Ave, Doral, Florida |
| Authorized Official Name and Position | Yessenia Martinez (PRESIDENT) |
| Authorized Official Contact | 7864205924 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1905 Nw 82nd Ave Doral FL 33126-1011 Ph: (786) 420-5924 | 1905 Nw 82nd Ave Doral FL 33126-1011 Ph: (786) 420-5924 |
| NPI Number | 1912334863 |
|---|---|
| Provider Enumeration Date | 10/07/2013 |
| Last Update Date | 07/21/2022 |
| Certification Date | 02/27/2020 |
| Medicare PECOS PAC ID | 2668791435 |
|---|---|
| Medicare Enrollment ID | O20150428002020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912334863 | NPI | - | NPPES |
| 009785300 | Medicaid | FL |
| Provider Name | Hamlet R Hassan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1326128323 PECOS PAC ID: 1153377452 Enrollment ID: I20050331000096 |
| Provider Name | Jorge E Fernandez Ramirez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1649557059 PECOS PAC ID: 8022243872 Enrollment ID: I20161107002260 |
| Provider Name | Mayuly Valdes Hernandez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326551847 PECOS PAC ID: 1355675232 Enrollment ID: I20190626002520 |
| Provider Name | Michael Ruiz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437498292 PECOS PAC ID: 2466771233 Enrollment ID: I20200505002053 |
| Provider Name | Laura Besada |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972117000 PECOS PAC ID: 3476963034 Enrollment ID: I20201110002002 |
| Provider Name | Luis Sinuhe Cabrera |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629696208 PECOS PAC ID: 5698130797 Enrollment ID: I20230425000679 |
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