Provider Demographics
NPI:1073338307
Name:MIAMI MENTAL HEALTH & WELLNESS LLC
Entity type:Organization
Organization Name:MIAMI MENTAL HEALTH & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YANISLEIDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MONDEJA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:786-937-9835
Mailing Address - Street 1:763 SE 18TH ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33034-5686
Mailing Address - Country:US
Mailing Address - Phone:786-937-9835
Mailing Address - Fax:786-937-9834
Practice Address - Street 1:763 SE 18TH ST
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33034-5686
Practice Address - Country:US
Practice Address - Phone:786-937-9835
Practice Address - Fax:786-937-9834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care