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8175 Nw 12th St Ste 119 Doral FL 33126-1828 | |
| (305) 300-2896 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 8175 Nw 12th St Ste 119, Doral, Florida |
| Authorized Official Name and Position | Laura J Parodi (PRESIDENT & CEO) |
| Authorized Official Contact | 3053002896 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
8175 Nw 12th St Ste 119 Doral FL 33126-1828 Ph: (305) 300-2896 | 8175 Nw 12th St Ste 119 Doral FL 33126-1828 Ph: (305) 300-2896 |
| NPI Number | 1265033575 |
|---|---|
| Provider Enumeration Date | 11/03/2020 |
| Last Update Date | 03/07/2024 |
| Certification Date | 03/07/2024 |
| Medicare PECOS PAC ID | 7012315997 |
|---|---|
| Medicare Enrollment ID | O20211006003295 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265033575 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Mirbelys Perera |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1952763542 PECOS PAC ID: 9830481977 Enrollment ID: I20191010001731 |
| Provider Name | Maria C. Gonzalez |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1083824627 PECOS PAC ID: 9537517156 Enrollment ID: I20231121000227 |
| Provider Name | Laura Parodi |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1518139054 PECOS PAC ID: 5799189411 Enrollment ID: I20231204003579 |
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