Provider Demographics
NPI:1972117224
Name:BEAUTIFUL MINDS MEDICAL CENTER LLC
Entity type:Organization
Organization Name:BEAUTIFUL MINDS MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GABRIELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARINELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-647-9499
Mailing Address - Street 1:23846 SW 116TH CT
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-7188
Mailing Address - Country:US
Mailing Address - Phone:305-647-9499
Mailing Address - Fax:305-508-6440
Practice Address - Street 1:11045 SW 216TH STREET
Practice Address - Street 2:UNIT 6
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33170
Practice Address - Country:US
Practice Address - Phone:305-647-9499
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch