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5390 Hoffner Ave Suite H Orlando FL 32812-2458 | |
| (407) 270-4849 | |
| (407) 381-0697 |
| Full Name | |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 5390 Hoffner Ave, Orlando, Florida |
| Authorized Official Name and Position | Delsy Guzman (PRESIDENT) |
| Authorized Official Contact | 4079288178 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
2052 Excalibur Dr Orlando FL 32822-8318 Ph: (407) 928-8178 | 5390 Hoffner Ave Suite H Orlando FL 32812-2458 Ph: (407) 270-4849 |
| NPI Number | 1407163926 |
|---|---|
| Provider Enumeration Date | 09/03/2010 |
| Last Update Date | 07/05/2016 |
| Medicare PECOS PAC ID | 0143646539 |
|---|---|
| Medicare Enrollment ID | O20200817000632 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407163926 | NPI | - | NPPES |
| 0168853800 | Medicaid | FL | |
| 811444700 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | MH5529 (Florida) | Primary |
| Provider Name | Miriam Csw Nieves |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1396212486 PECOS PAC ID: 4486070893 Enrollment ID: I20200817001191 |
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