Provider Demographics
NPI:1073357745
Name:A MINDFULNESS SPACE
Entity type:Organization
Organization Name:A MINDFULNESS SPACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VIRMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-339-6299
Mailing Address - Street 1:7901 4TH ST N STE 18631
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-4305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7901 4TH ST N STE 18631
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-4305
Practice Address - Country:US
Practice Address - Phone:386-961-4006
Practice Address - Fax:402-235-4945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-19
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health