Provider Demographics
NPI:1114255163
Name:SELF ENRICHMENT CENTER OF SOUTH MIAMI
Entity Type:Organization
Organization Name:SELF ENRICHMENT CENTER OF SOUTH MIAMI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:305-669-2715
Mailing Address - Street 1:7600 RED RD STE 309
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-5427
Mailing Address - Country:US
Mailing Address - Phone:305-669-2715
Mailing Address - Fax:
Practice Address - Street 1:7600 RED RD STE 309
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5427
Practice Address - Country:US
Practice Address - Phone:305-669-2715
Practice Address - Fax:305-669-2689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-03
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 23392174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty