MMD Professional Services Corp

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

MMD PROFESSIONAL SERVICES CORP

Practice address

1680 SW Bayshore Boulevard
Suite 100
Port St. Lucie, FL 34984

Phone

(786) 715-7072

NPI assigned

May 16, 2022

Last updated

May 16, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Miguel H Garcia PedrajaNPI 1528572948

Title

Bcba

Phone

(786) 715-7072

Specialties & licenses 1

Addresses

Tax ID family

MMD Professional Services Corp2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• MMD Professional Services, Corp.

  • Behavior Analyst
  • Port St Lucie, FL
  • NPI 1740926757
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Miguel Humberto Garcia Pedraja

  • Behavior Analyst
  • Miami Gardens, FL
  • NPI 1528572948
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1652659200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652659200000",
    "number": "1477290096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13311 GRANGER AVE",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328273857",
            "telephone_number": "786-715-7072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1680 SW BAYSHORE BOULEVARD",
            "address_2": "SUITE 100",
            "city": "PORT ST. LUCIE",
            "state": "FL",
            "postal_code": "34984",
            "telephone_number": "786-715-7072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MMD PROFESSIONAL SERVICES CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-16",
        "last_updated": "2022-05-16",
        "certification_date": "2022-04-19",
        "status": "A",
        "authorized_official_last_name": "GARCIA PEDRAJA",
        "authorized_official_first_name": "MIGUEL",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "BCBA",
        "authorized_official_telephone_number": "786-715-7072"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Krystal Leeann Misner
• Audrey Mitchell
• Sarah Amy Mitchell, LCSW
• Dieudonne Mitial, M.D., M.H.S.A
• Mizada Inc (Mizada Assistant Living facility)
• MMD Professional Services, Corp.
• Mobile Medical Operating Company LLC (Mobile Medical)
• Mobile Physical Therapy, Inc.
• Jacqueline Mobley
• Nacole A Moffat McGarry, LCSW

• Clinic/Center in Port St Lucie, FL
• Providers in Port St Lucie, FL by specialty
• Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.