Organization
COMMUNITY MENTAL HEALTH AND WELLNESS CENTER OF DORAL INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA RODRIGUEZ (PRESIDENT)
(786) 490-0974
Entity
Organization
Contact information
Practice address
9300 NW 25TH ST STE 106, DORAL, FL 33172-1506
(786) 320-4603
Mailing address
9300 NW 25TH ST STE 106, DORAL, FL 33172-1506
(786) 320-4603
Taxonomy
Speciality
Code
Description
License number
State
102L00000X
Psychoanalyst
—
—
2084P0800X
Psychiatry Physician
—
—
261QC1500X
Community Health Clinic/Center
—
—
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
HCC12703
AHCA
FL
Enumeration date
07/13/2017
Last updated
03/27/2018
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