Provider Demographics
NPI:1598507618
Name:CLINICA DEL BUEN SAMARITANO,INC
Entity type:Organization
Organization Name:CLINICA DEL BUEN SAMARITANO,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:TAPIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:754-221-9238
Mailing Address - Street 1:571 SW 142ND AVE # 403-0
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027-6925
Mailing Address - Country:US
Mailing Address - Phone:754-221-9238
Mailing Address - Fax:
Practice Address - Street 1:571 SW 142ND AVE # 403-0
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027-6925
Practice Address - Country:US
Practice Address - Phone:754-221-9238
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty