Provider Demographics
NPI: | 1639562499 |
---|---|
Name: | ORION HUMANUS MEDICAL GROUP LLC |
Entity Type: | Organization |
Organization Name: | ORION HUMANUS MEDICAL GROUP LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | ADMINISTRATOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | ANALAY |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | CERRO |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 305-267-8277 |
Mailing Address - Street 1: | 7360 CORAL WAY STE 23B |
Mailing Address - Street 2: | |
Mailing Address - City: | MIAMI |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33155-1482 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 305-267-8277 |
Mailing Address - Fax: | 305-267-8277 |
Practice Address - Street 1: | 7360 CORAL WAY STE 23B |
Practice Address - Street 2: | |
Practice Address - City: | MIAMI |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33155-1482 |
Practice Address - Country: | US |
Practice Address - Phone: | 305-267-8277 |
Practice Address - Fax: | 305-267-8277 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2015-03-17 |
Last Update Date: | 2015-03-17 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
101YA0400X, 101YM0800X, 103T00000X, 103TA0400X, 103TC2200X, 103TM1800X, 103TP2701X, 1041C0700X, 106H00000X, 171100000X, 2084B0040X | ||
FL | 27841 | 207L00000X |
FL | 39411 | 225700000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 2084B0040X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Behavioral Neurology & Neuropsychiatry | Group - Multi-Specialty |
No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
No | 103TA0400X | Behavioral Health & Social Service Providers | Psychologist | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
No | 103TC2200X | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | Group - Multi-Specialty |
No | 103TM1800X | Behavioral Health & Social Service Providers | Psychologist | Intellectual & Developmental Disabilities | Group - Multi-Specialty |
No | 103TP2701X | Behavioral Health & Social Service Providers | Psychologist | Group Psychotherapy | Group - Multi-Specialty |
No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
No | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | Group - Multi-Specialty | |
No | 171100000X | Other Service Providers | Acupuncturist | Group - Multi-Specialty | |
No | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | Group - Multi-Specialty | |
No | 225700000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist | Group - Multi-Specialty |