Organization
LIGHT OF HOPE BEHAVIOR THERAPY INC
Active
Other names
Light of Hope Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
TANIA H PEREZ GONZALEZ (CEO)
(786) 404-1008
Entity
Organization
Contact information
Practice address
15190 SW 136TH ST STE 26-27, MIAMI, FL 33196-2604
(786) 404-1008
(305) 747-7166
Mailing address
15190 SW 136TH ST STE 26, MIAMI, FL 33196-2618
(786) 404-1008
(305) 747-7166
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
115780900
—
FL
Enumeration date
06/20/2022
Last updated
06/14/2023
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