Provider Demographics
NPI:1356989958
Name:MI QUERIDO VIEJO INC
Entity type:Organization
Organization Name:MI QUERIDO VIEJO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JISELL
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ ARRIETA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-575-4447
Mailing Address - Street 1:677 SW 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33130-1203
Mailing Address - Country:US
Mailing Address - Phone:786-575-4447
Mailing Address - Fax:
Practice Address - Street 1:677 SW 1ST ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33130-1203
Practice Address - Country:US
Practice Address - Phone:786-575-4447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-13
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health