Provider Demographics
NPI:1295110559
Name:ADDICTION DOCTORS OF SOUTH FLORIDA
Entity type:Organization
Organization Name:ADDICTION DOCTORS OF SOUTH FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MYLAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:RIOBE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-440-4156
Mailing Address - Street 1:1001 SE MONTEREY COMMONS BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34996-3329
Mailing Address - Country:US
Mailing Address - Phone:561-440-4156
Mailing Address - Fax:
Practice Address - Street 1:1001 SE MONTEREY COMMONS BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34996-3329
Practice Address - Country:US
Practice Address - Phone:561-440-4156
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-28
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82630261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH45592Medicare UPIN