Provider Demographics
NPI:1477990869
Name:BLUE DOLPHIN HEALTH CARE, CORP.
Entity Type:Organization
Organization Name:BLUE DOLPHIN HEALTH CARE, CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADULT PSYCHIATRY-NP /OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ASUNCION
Authorized Official - Middle Name:MARINA
Authorized Official - Last Name:MUNOZ
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:786-553-0954
Mailing Address - Street 1:777 E 25TH ST
Mailing Address - Street 2:# 302
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-3825
Mailing Address - Country:US
Mailing Address - Phone:786-553-0954
Mailing Address - Fax:786-502-2503
Practice Address - Street 1:777 E 25TH ST
Practice Address - Street 2:# 302
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-3825
Practice Address - Country:US
Practice Address - Phone:786-553-0954
Practice Address - Fax:786-502-2503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-27
Last Update Date:2013-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8287101YM0800X
FL9292609363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLEL117AOtherPTAN