Provider Demographics
NPI:1568922763
Name:HEALING YOUR MIND CORP
Entity Type:Organization
Organization Name:HEALING YOUR MIND CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:GAMEZ PARDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-366-4296
Mailing Address - Street 1:7925 NW 12TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33126-1821
Mailing Address - Country:US
Mailing Address - Phone:305-874-3909
Mailing Address - Fax:305-874-3916
Practice Address - Street 1:1176 SW 67TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-4700
Practice Address - Country:US
Practice Address - Phone:305-359-9838
Practice Address - Fax:786-224-6490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-22
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110048300Medicaid