Organization
ENERGY COMMUNITY MENTAL HEALTH CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERNESTO RODRIGUEZ TANQUERO (PRESIDENT)
(786) 227-2966
Entity
Organization
Contact information
Practice address
4995 NW 72ND AVE STE 102, MIAMI, FL 33166-5643
(786) 227-2966
Mailing address
4995 NW 72ND AVE STE 102, MIAMI, FL 33166-5643
(786) 227-2966
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
207Q00000X
Family Medicine Physician
Primary
—
—
251B00000X
Case Management Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QP2000X
Physical Therapy Clinic/Center
—
—
Other
Enumeration date
03/17/2021
Last updated
11/21/2023
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