Organization Name: | DIVERSIFIED MENTAL HEALTH CARE CENTER INC |
NPI Number: | 1093987059 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JACQUELINE GAINZA (PRESIDENT) |
Mailing Address: | 10961 Sw 186th St Cutler Bay |
State: | FL US |
Postal Code: | 331576808 |
Phone Number: | 3052569996 |
Fax Number: | |
NPI Enumeration Date: | 03/31/2008 |
NPI Last Update Date: | 12/16/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | HCC8173 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |