Provider Demographics
NPI:1861589095
Name:PSYCHSTAR
Entity type:Organization
Organization Name:PSYCHSTAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:ERNESTO
Authorized Official - Last Name:GARRIDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-631-8876
Mailing Address - Street 1:351 NW 42ND AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-5683
Mailing Address - Country:US
Mailing Address - Phone:305-631-8876
Mailing Address - Fax:305-631-0556
Practice Address - Street 1:351 NW 42ND AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-5683
Practice Address - Country:US
Practice Address - Phone:305-631-8876
Practice Address - Fax:305-631-0556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00420252174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty