| Social Diversity Llc | |
|
12001 Sw 128th Ct Ste 101 Miami FL 33186-4665 | |
| (786) 975-7485 | |
| Not Available |
| Full Name | Social Diversity Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 12001 Sw 128th Ct Ste 101, Miami, Florida |
| Authorized Official Name and Position | Esel Aguilar (OWNER/CEO) |
| Authorized Official Contact | 7869757485 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Social Diversity Llc 382 Ne 19th Ave Homestead FL 33033-5265 Ph: (786) 975-7485 | Social Diversity Llc 12001 Sw 128th Ct Ste 101 Miami FL 33186-4665 Ph: (786) 975-7485 |
| NPI Number | 1245863448 |
|---|---|
| Provider Enumeration Date | 02/16/2020 |
| Last Update Date | 05/17/2022 |
| Medicare PECOS PAC ID | 4284033697 |
|---|---|
| Medicare Enrollment ID | O20210604000059 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245863448 | NPI | - | NPPES |
| CBHCMS100118 | Other | FL | FLORIDA CERTIFICATION BOARD |
| Provider Name | Natacha Martinez Padrino |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1427237528 PECOS PAC ID: 2961418728 Enrollment ID: I20060303000152 |
| Provider Name | Laritza Varona Gonzalez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427691674 PECOS PAC ID: 9830555424 Enrollment ID: I20230524002617 |
| Provider Name | Damarys Crane |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1013419787 PECOS PAC ID: 7012322944 Enrollment ID: I20240306003677 |
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