| San Miguel Community Wellness Center | |
|
12030 Sw 129th Ct Ste 107 Miami FL 33186-4584 | |
| (305) 432-4032 | |
| (855) 461-3440 |
| Full Name | San Miguel Community Wellness Center |
|---|---|
| Speciality | Case Management |
| Location | 12030 Sw 129th Ct Ste 107, Miami, Florida |
| Authorized Official Name and Position | Miguel Novoa (PRESIDENT) |
| Authorized Official Contact | 3054324032 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| San Miguel Community Wellness Center 12030 Sw 129th Ct Ste 107 Miami FL 33186-4584 Ph: (305) 432-4032 | San Miguel Community Wellness Center 12030 Sw 129th Ct Ste 107 Miami FL 33186-4584 Ph: (305) 432-4032 |
| NPI Number | 1073112603 |
|---|---|
| Provider Enumeration Date | 10/24/2020 |
| Last Update Date | 01/25/2024 |
| Certification Date | 01/25/2024 |
| Medicare PECOS PAC ID | 9436568227 |
|---|---|
| Medicare Enrollment ID | O20210507000072 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073112603 | NPI | - | NPPES |
| Provider Name | Elizabeth A Gingerich |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1184246456 PECOS PAC ID: 1658783048 Enrollment ID: I20201208002694 |
| Provider Name | Jessica S Novoa |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1699351882 PECOS PAC ID: 6608285499 Enrollment ID: I20210510000620 |
| Provider Name | Luis Cruz |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1871852020 PECOS PAC ID: 1658779905 Enrollment ID: I20211018001346 |
| Provider Name | Tamara Guerra Alfonso |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1154810661 PECOS PAC ID: 2769876903 Enrollment ID: I20220303001730 |
| Provider Name | Dana Garcia Gonzalez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114687696 PECOS PAC ID: 5395126312 Enrollment ID: I20220721001332 |
| Provider Name | Nacin Fernandez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1306567144 PECOS PAC ID: 1557737319 Enrollment ID: I20230217001505 |
| Provider Name | Beatriz A Fernandez-gregson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588340004 PECOS PAC ID: 1153778170 Enrollment ID: I20231114000617 |
| Provider Name | Aixa Nunez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1952001018 PECOS PAC ID: 2062852015 Enrollment ID: I20240424003791 |
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