| Group | |
|
407 Lincoln Rd #6k Miami Beach FL 33139 | |
| (305) 672-1104 | |
| (305) 672-1385 |
| Full Name | Group |
|---|---|
| Speciality | Psychologist |
| Location | 407 Lincoln Rd, Miami Beach, Florida |
| Authorized Official Name and Position | Julieta Raquel Rodriguez (PRESIDENT OWNER) |
| Authorized Official Contact | 3056721104 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Group 407 Lincoln Rd #6k Miami Beach FL 33139 Ph: (305) 672-1104 | Group 407 Lincoln Rd #6k Miami Beach FL 33139 Ph: (305) 672-1104 |
| NPI Number | 1790950236 |
|---|---|
| Provider Enumeration Date | 04/25/2008 |
| Last Update Date | 04/25/2008 |
| Medicare PECOS PAC ID | 2567487572 |
|---|---|
| Medicare Enrollment ID | O20051010000258 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790950236 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PY6411 (ZZ) | Primary |
| Provider Name | Julieta Rodriguez |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1528100179 PECOS PAC ID: 6002831013 Enrollment ID: I20051013000966 |
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