Organization
MIND AND SOUL MEDICAL THERAPY INC.
Active
Organization
MIND AND SOUL MEDICAL THERAPY INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RODOLFO RUANO DIEGUEZ (OWNER)
(786) 282-9730
Entity
Organization
Contact information
Practice address
7911 NW 72ND AVE STE 115, MEDLEY, FL 33166-2221
(786) 953-8744
Mailing address
7911 NW 72ND AVE STE 115, MEDLEY, FL 33166-2221
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
109315200
—
FL
Enumeration date
01/19/2021
Last updated
03/19/2021
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