Provider Demographics
NPI:1043893316
Name:MINT CLINIC LLC
Entity Type:Organization
Organization Name:MINT CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:DIEGO
Authorized Official - Middle Name:E
Authorized Official - Last Name:ROCA
Authorized Official - Suffix:
Authorized Official - Credentials:NONE
Authorized Official - Phone:561-614-1090
Mailing Address - Street 1:1201 US HIGHWAY 1 STE 305
Mailing Address - Street 2:
Mailing Address - City:NORTH PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-3548
Mailing Address - Country:US
Mailing Address - Phone:917-331-4321
Mailing Address - Fax:
Practice Address - Street 1:1201 US HIGHWAY 1 STE 305
Practice Address - Street 2:
Practice Address - City:NORTH PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-3548
Practice Address - Country:US
Practice Address - Phone:917-331-4321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center