Provider Demographics
NPI:1518660505
Name:PRESTIGE HEALTH GROUP LLC
Entity Type:Organization
Organization Name:PRESTIGE HEALTH GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:RBT, CBHCM, MS
Authorized Official - Phone:305-283-6183
Mailing Address - Street 1:11401 SW 40TH ST STE 319
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-3339
Mailing Address - Country:US
Mailing Address - Phone:305-283-6183
Mailing Address - Fax:
Practice Address - Street 1:11401 SW 40TH ST STE 319
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-3339
Practice Address - Country:US
Practice Address - Phone:305-283-6183
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty