Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Myrtle Ridge Primary Care, PA

Organization Mental Health Counselor · NPI 1619504354

Myrtle Ridge Primary Care, PA is a Mental Health Counselor in Lutz, Florida. Registered with an NPI since 2020.

In the registry since
2020
Specialties on file
4
What do these letters mean?
PA — Professional association
A form of business registration, not a clinical qualification.

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Practice location Address checks out

1539 Dale Mabry Hwy Ste 102
Lutz, FL 33548-3008
Phone: (813) 909-7102
Fax: (813) 909-0199
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

General Practice Physician (primary) Taxonomy 208D00000X
Mental Health Counselor Taxonomy 101YM0800X
Psychologist Taxonomy 103T00000X
Physician Assistant Taxonomy 363A00000X

Record details

NPI number1619504354
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Yudaisy Mogena Padron — Owner · (813) 909-7102
Other names Myrtle Ridge Primary Care, P.A
NPI enumeratedMarch 24, 2020
Last updated in NPPESJanuary 8, 2026
Certification dateJanuary 8, 2026
Mailing address1539 Dale Mabry Hwy Ste 102, Lutz, FL 33548-3008

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