| Magnolia Community Mental Health Center Llc | |
|
2513 W Hillsborough Ave Ste 210 Tampa FL 33614-6122 | |
| (813) 450-1052 | |
| Not Available |
| Full Name | Magnolia Community Mental Health Center Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2513 W Hillsborough Ave Ste 210, Tampa, Florida |
| Authorized Official Name and Position | Sunamys Miralles Cardet (OWNER) |
| Authorized Official Contact | 8134435530 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Magnolia Community Mental Health Center Llc 2513 W Hillsborough Ave Ste 210 Tampa FL 33614-6122 Ph: (813) 450-1052 | Magnolia Community Mental Health Center Llc 2513 W Hillsborough Ave Ste 210 Tampa FL 33614-6122 Ph: (813) 450-1052 |
| NPI Number | 1598361719 |
|---|---|
| Provider Enumeration Date | 12/11/2020 |
| Last Update Date | 09/14/2023 |
| Certification Date | 09/14/2023 |
| Medicare PECOS PAC ID | 3274930243 |
|---|---|
| Medicare Enrollment ID | O20210920000856 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598361719 | NPI | - | NPPES |
| Provider Name | Carlos Alberto Salazar |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1215900931 PECOS PAC ID: 5698798627 Enrollment ID: I20060105000349 |
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