| Spectrum Mental Health Corp | |
|
1901 W Flagler St Ste 7 Miami FL 33135-1677 | |
| (786) 457-8256 | |
| Not Available |
| Full Name | Spectrum Mental Health Corp |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1901 W Flagler St Ste 7, Miami, Florida |
| Authorized Official Name and Position | Rafael Mario Prado (PRESIDENT) |
| Authorized Official Contact | 7864578256 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Spectrum Mental Health Corp 1901 W Flagler St Ste 7 Miami FL 33135-1677 Ph: (786) 457-8256 | Spectrum Mental Health Corp 1901 W Flagler St Ste 7 Miami FL 33135-1677 Ph: (786) 457-8256 |
| NPI Number | 1487435418 |
|---|---|
| Provider Enumeration Date | 10/05/2023 |
| Last Update Date | 10/05/2023 |
| Certification Date | 10/05/2023 |
| Medicare PECOS PAC ID | 7911438098 |
|---|---|
| Medicare Enrollment ID | O20240930003330 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487435418 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Yonatan Colon Rivera |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1144777517 PECOS PAC ID: 8325448236 Enrollment ID: I20210615001511 |
| Provider Name | Grettel Carballo |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1073185864 PECOS PAC ID: 3971941634 Enrollment ID: I20240401002873 |
| Provider Name | Victor Gonzalez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083076905 PECOS PAC ID: 3274066824 Enrollment ID: I20241104003074 |
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