Provider Demographics
NPI:1750010880
Name:BUITRAGO, FRANK
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:
Last Name:BUITRAGO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8906 W FLAGLER ST APT 103
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-3928
Mailing Address - Country:US
Mailing Address - Phone:305-330-2362
Mailing Address - Fax:
Practice Address - Street 1:1250 NW 7TH ST STE 209
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-3744
Practice Address - Country:US
Practice Address - Phone:305-642-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL86-2388083Medicaid