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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