Provider Demographics
NPI:1003911462
Name:COBRE BEHAVIORAL & HEALTH CLINIC CORPORATION
Entity Type:Organization
Organization Name:COBRE BEHAVIORAL & HEALTH CLINIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DELIO
Authorized Official - Middle Name:
Authorized Official - Last Name:TREJO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-553-6726
Mailing Address - Street 1:306 N.W. 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-3031
Mailing Address - Country:US
Mailing Address - Phone:786-394-8888
Mailing Address - Fax:786-394-8777
Practice Address - Street 1:306 N.W. 27TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-3031
Practice Address - Country:US
Practice Address - Phone:786-394-8888
Practice Address - Fax:786-394-8777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH4008101YM0800X
FLPY5395103G00000X, 103TC0700X
FLPY7224103TC0700X
FLRN3143962163W00000X
FLME67164207Q00000X
FLME403042084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Not Answered163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1932135969OtherNPI
FL1134151483OtherNPI
FL1184639569OtherNPI
FL54114Medicare ID - Type Unspecified
FL26194Medicare ID - Type Unspecified
FL1184639569OtherNPI
FLF95237Medicare UPIN
FLU6827Medicare ID - Type Unspecified
FL96638Medicare ID - Type Unspecified
FL1134151483OtherNPI