Organization · NPI-2
125th Street Nm Corp
Psychiatry & Neurology, Addiction Psychiatry · North Miami, FL
NPI number1619352283
StatusActive
Last updated in NPPESApr 7, 2016
Details
- NPI
- 1619352283
- Entity type
- Organization (NPI-2)
- Legal business name
- 125th Street Nm Corp
- Organization subpart
- No
- Enumeration date
- Jul 24, 2015
- Last updated
- Apr 7, 2016
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2084P0802X | Psychiatry & Neurology, Addiction Psychiatry | – | – | Yes |
| 174400000X | Specialist | – | – | |
| 261QP2000X | Clinic/Center, Physical Therapy | PMC20 | FL |
Practice location
505 Ne 125th StNorth Miami, FL 33161-4718
Phone 954-271-0485
Mailing address
505 Ne 125th StNorth Miami, FL 33161-4718
Phone 954-271-0485
Authorized official
Renee Douthat
Cdo
9542710485
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