Provider Demographics
NPI:1275240160
Name:MEDBLUE HEALTH CORP
Entity Type:Organization
Organization Name:MEDBLUE HEALTH CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:LISSETT
Authorized Official - Last Name:RUIZ ALVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:RBT
Authorized Official - Phone:786-660-8104
Mailing Address - Street 1:2837 W 75TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-5314
Mailing Address - Country:US
Mailing Address - Phone:786-660-8104
Mailing Address - Fax:
Practice Address - Street 1:2837 W 75TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-5314
Practice Address - Country:US
Practice Address - Phone:786-660-8104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-01
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty