Provider Demographics
NPI:1740926757
Name:MMD PROFESSIONAL SERVICES, CORP.
Entity type:Organization
Organization Name:MMD PROFESSIONAL SERVICES, CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-715-7072
Mailing Address - Street 1:1680 SW BAYSHORE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34984-3518
Mailing Address - Country:US
Mailing Address - Phone:772-610-3947
Mailing Address - Fax:772-610-3952
Practice Address - Street 1:1680 SW BAYSHORE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34984-3518
Practice Address - Country:US
Practice Address - Phone:772-610-3947
Practice Address - Fax:772-610-3952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty