Provider Demographics
NPI:1487015533
Name:MEDICAL & PSYCHIATRIC HEALTH RESEARCH GROUP OF FLORIDA
Entity Type:Organization
Organization Name:MEDICAL & PSYCHIATRIC HEALTH RESEARCH GROUP OF FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:P
Authorized Official - Last Name:NORIEGA
Authorized Official - Suffix:
Authorized Official - Credentials:EHA MBA
Authorized Official - Phone:305-747-8866
Mailing Address - Street 1:15135 NW 89TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33018-1364
Mailing Address - Country:US
Mailing Address - Phone:305-747-8866
Mailing Address - Fax:305-508-6622
Practice Address - Street 1:15135 NW 89TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33018-1364
Practice Address - Country:US
Practice Address - Phone:305-747-8866
Practice Address - Fax:305-508-6622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-17
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9100829302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization