Provider Demographics
NPI:1902670359
Name:MUGUERCIA CHALES, JENNIFER (CBHCM-P)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MUGUERCIA CHALES
Suffix:
Gender:F
Credentials:CBHCM-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4690 E 8TH LN
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-2008
Mailing Address - Country:US
Mailing Address - Phone:786-906-4884
Mailing Address - Fax:
Practice Address - Street 1:900 E 9TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-4650
Practice Address - Country:US
Practice Address - Phone:305-381-5294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-07
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCBHCM.0106249-P171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator