1871108308 NPI number — MRS PSYCHIATRY CORP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871108308 NPI number — MRS PSYCHIATRY CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MRS PSYCHIATRY CORP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871108308
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/18/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
52 S ROYAL POINCIANA BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI SPRINGS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33166-6059
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-200-7681
Provider Business Mailing Address Fax Number:
305-847-2447

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
52 S ROYAL POINCIANA BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI SPRINGS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33166-6059
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-200-7681
Provider Business Practice Location Address Fax Number:
305-847-2447
Provider Enumeration Date:
09/11/2020

Additional Information

Authorized Official

Authorized Official Last Name:
RUIZ SANTIAGO
Authorized Official First Name:
MAYTE
Authorized Official Middle Name:
SOLANGE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
786-536-1701

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 109931900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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