Organization
OPEN TIME SUPPORT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. HECTOR PAULINO GONZALEZ BCABA (PRESIDENT)
(786) 317-2004
Entity
Organization
Contact information
Practice address
15075 SW 63RD TER, MIAMI, FL 33193-2784
(786) 317-2004
(305) 388-1570
Mailing address
15075 SW 63RD TER, MIAMI, FL 33193-2784
(786) 317-2004
(305) 388-1570
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
FL
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
05/16/2012
Last updated
05/16/2012
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