Provider Demographics
NPI:1164566683
Name:MENTAL HEALTH SERVICES OF FLORIDA PA
Entity Type:Organization
Organization Name:MENTAL HEALTH SERVICES OF FLORIDA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISING PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SAJID
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-667-8114
Mailing Address - Street 1:7550 S RED RD
Mailing Address - Street 2:211
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-5343
Mailing Address - Country:US
Mailing Address - Phone:305-667-8114
Mailing Address - Fax:786-513-0143
Practice Address - Street 1:7550 S RED RD
Practice Address - Street 2:211
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5343
Practice Address - Country:US
Practice Address - Phone:305-667-8114
Practice Address - Fax:786-513-0143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-17
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME71772084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL277173000Medicaid