| Tampa Bay Mental Health, Llc | |
|
6916 W Linebaugh Ave Ste 102 Tampa FL 33625-5815 | |
| (813) 269-2920 | |
| (813) 269-2921 |
| Full Name | Tampa Bay Mental Health, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 6916 W Linebaugh Ave Ste 102, Tampa, Florida |
| Authorized Official Name and Position | Alain Santos Perez (OWNER) |
| Authorized Official Contact | 8132692920 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tampa Bay Mental Health, Llc 6916 W Linebaugh Ave Ste 102 Tampa FL 33625-5815 Ph: (813) 269-2920 | Tampa Bay Mental Health, Llc 6916 W Linebaugh Ave Ste 102 Tampa FL 33625-5815 Ph: (813) 269-2920 |
| NPI Number | 1710570734 |
|---|---|
| Provider Enumeration Date | 02/19/2021 |
| Last Update Date | 06/19/2024 |
| Certification Date | 06/19/2024 |
| Medicare PECOS PAC ID | 4981094620 |
|---|---|
| Medicare Enrollment ID | O20211211000038 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710570734 | NPI | - | NPPES |
| 109622100 | Medicaid | FL | |
| 109622101 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| 261QC1500X | Clinic/center - Community Health | (* (Not Available)) | Primary |
| Provider Name | Orlando Lazaro Ruano |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1013021138 PECOS PAC ID: 0749254225 Enrollment ID: I20040820000868 |
| Provider Name | Joseph Grimaldi |
|---|---|
| Provider Type | Practitioner - Psychologist Billing Independently |
| Provider Identifiers | NPI Number: 1902018419 PECOS PAC ID: 1850352071 Enrollment ID: I20041021000377 |
| Provider Name | Stefanny M Molina Mesa |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851909212 PECOS PAC ID: 9830593037 Enrollment ID: I20210810003724 |
| Provider Name | Yanet Fernandez Diaz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215653589 PECOS PAC ID: 5496106619 Enrollment ID: I20240111002651 |
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