Provider Demographics
NPI:1770351090
Name:PROHEALTH THERAPEUTIC SERVICES, LLC
Entity type:Organization
Organization Name:PROHEALTH THERAPEUTIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:MARIELYS
Authorized Official - Middle Name:
Authorized Official - Last Name:PINO PAEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-442-0873
Mailing Address - Street 1:1801 CORAL WAY STE 329
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-2784
Mailing Address - Country:US
Mailing Address - Phone:786-442-0873
Mailing Address - Fax:
Practice Address - Street 1:1801 CORAL WAY STE 329
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-2784
Practice Address - Country:US
Practice Address - Phone:786-442-0873
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-15
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty