| Vytalyze Minds Corp | |
|
2300 W 84th St Ste 601 Hialeah FL 33016-5780 | |
| (305) 363-4001 | |
| (305) 363-4002 |
| Full Name | Vytalyze Minds Corp |
|---|---|
| Speciality | Clinic/Center |
| Location | 2300 W 84th St Ste 601, Hialeah, Florida |
| Authorized Official Name and Position | Osvaldo Leon Herrera (P) |
| Authorized Official Contact | 3053634001 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vytalyze Minds Corp 2300 W 84th St Ste 601 Miami Lakes FL 33016-5780 Ph: (305) 363-4001 | Vytalyze Minds Corp 2300 W 84th St Ste 601 Hialeah FL 33016-5780 Ph: (305) 363-4001 |
| NPI Number | 1588275150 |
|---|---|
| Provider Enumeration Date | 08/16/2020 |
| Last Update Date | 02/28/2025 |
| Certification Date | 02/28/2025 |
| Medicare PECOS PAC ID | 3779972583 |
|---|---|
| Medicare Enrollment ID | O20211117001443 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588275150 | NPI | - | NPPES |
| 672191 | Other | FL | JCAHO |
| 107794500 | Medicaid | FL | |
| 12488 | Other | FL | AHCA |
| Provider Name | Eric A Robbins |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1629398961 PECOS PAC ID: 9436370095 Enrollment ID: I20151120002523 |
| Provider Name | Tara M Kellogg |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1023267416 PECOS PAC ID: 3779928320 Enrollment ID: I20240319000390 |
| Provider Name | Catherine Alvarez |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1326881533 PECOS PAC ID: 3678007424 Enrollment ID: I20241115001520 |
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