Provider Demographics
NPI:1275760779
Name:PALM PSYCHIATRIC, INC
Entity Type:Organization
Organization Name:PALM PSYCHIATRIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-598-8000
Mailing Address - Street 1:10631 N KENDALL DR
Mailing Address - Street 2:SUITE 125
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1568
Mailing Address - Country:US
Mailing Address - Phone:305-598-8000
Mailing Address - Fax:
Practice Address - Street 1:10631 N KENDALL DR
Practice Address - Street 2:SUITE 125
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1568
Practice Address - Country:US
Practice Address - Phone:305-598-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-11
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86541103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG13030Medicare UPIN