Provider Demographics
NPI:1871527127
Name:MEDICAL AND PSYCHIATRIC HEALTH GROUP OF MIAMI LLC
Entity type:Organization
Organization Name:MEDICAL AND PSYCHIATRIC HEALTH GROUP OF MIAMI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:NORIEGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-444-3333
Mailing Address - Street 1:3485 W FLAGLER ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-1042
Mailing Address - Country:US
Mailing Address - Phone:305-444-3333
Mailing Address - Fax:305-444-7044
Practice Address - Street 1:3485 W FLAGLER ST
Practice Address - Street 2:SUITE 500
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-1042
Practice Address - Country:US
Practice Address - Phone:305-444-3333
Practice Address - Fax:305-444-7044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK3954Medicare ID - Type Unspecified