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7270 Nw 12th St Ste 430 Miami FL 33126-1941 | |
| (786) 615-2843 | |
| (786) 980-1607 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 7270 Nw 12th St Ste 430, Miami, Florida |
| Authorized Official Name and Position | Ailen Cruz Bergon (PRESIDENT) |
| Authorized Official Contact | 7866152843 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
7270 Nw 12th St Ste 430 Miami FL 33126-1941 Ph: (786) 615-2843 | 7270 Nw 12th St Ste 430 Miami FL 33126-1941 Ph: (786) 615-2843 |
| NPI Number | 1508468869 |
|---|---|
| Provider Enumeration Date | 11/12/2020 |
| Last Update Date | 10/18/2022 |
| Certification Date | 10/18/2022 |
| Medicare PECOS PAC ID | 8224428826 |
|---|---|
| Medicare Enrollment ID | O20211213002415 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508468869 | NPI | - | NPPES |
| Provider Name | Katrina A Forman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447538269 PECOS PAC ID: 1658785233 Enrollment ID: I20210121001896 |
| Provider Name | Michelle M Lebron Ginorio |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1932762705 PECOS PAC ID: 0648627182 Enrollment ID: I20231106001936 |
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