| One Soul Cmh, Inc | |
|
5901 Nw 183rd St Ste 128 Hialeah FL 33015-6009 | |
| (786) 332-4965 | |
| (786) 362-6077 |
| Full Name | One Soul Cmh, Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 5901 Nw 183rd St Ste 128, Hialeah, Florida |
| Authorized Official Name and Position | Yulexis Navarro (ADMINISTRATOR) |
| Authorized Official Contact | 7864094872 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| One Soul Cmh, Inc 5901 Nw 183rd St Ste 128 Miami Gardens FL 33015-6009 Ph: (786) 409-4872 | One Soul Cmh, Inc 5901 Nw 183rd St Ste 128 Hialeah FL 33015-6009 Ph: (786) 332-4965 |
| NPI Number | 1447823430 |
|---|---|
| Provider Enumeration Date | 07/19/2021 |
| Last Update Date | 12/12/2024 |
| Certification Date | 12/12/2024 |
| Medicare PECOS PAC ID | 5496145591 |
|---|---|
| Medicare Enrollment ID | O20211203001720 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447823430 | NPI | - | NPPES |
| 024524700 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Antonia E Ruaix |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1023029626 PECOS PAC ID: 7810051745 Enrollment ID: I20120905000110 |
| Provider Name | Zaide Laurido |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710432315 PECOS PAC ID: 8921375395 Enrollment ID: I20170606003069 |
| Provider Name | Carlos Alberto Autie |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912515768 PECOS PAC ID: 2769801588 Enrollment ID: I20200929000527 |
| Provider Name | Jorge Luis Jorge |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1366949737 PECOS PAC ID: 9537564687 Enrollment ID: I20210827000257 |
| Provider Name | Osvaldo A Carmona |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1346864931 PECOS PAC ID: 5698134492 Enrollment ID: I20230712001271 |
| Provider Name | Clarisa Carballo |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1831359835 PECOS PAC ID: 9032550637 Enrollment ID: I20240514002411 |
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