Provider Demographics
NPI:1427326800
Name:SOUTH FLORIDA ADHD CENTER INC.
Entity type:Organization
Organization Name:SOUTH FLORIDA ADHD CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARISELA
Authorized Official - Middle Name:CARMEN
Authorized Official - Last Name:JAQUEZ-GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-392-6784
Mailing Address - Street 1:11341 NW 50TH TER
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-3545
Mailing Address - Country:US
Mailing Address - Phone:305-392-6784
Mailing Address - Fax:
Practice Address - Street 1:17901 NW 5TH ST STE 103
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-2810
Practice Address - Country:US
Practice Address - Phone:305-392-6784
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME70979261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL251098700Medicaid
FL32539Medicare PIN