MEDICARE: SPECTRA HEALTH & WELLNESS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1043778186
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECTRA HEALTH & WELLNESS LLC

Provider Business Mailing Address
First Line	:	101 N US HIGHWAY 1 STE 213
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-4262
Country	:	US
Telephone Number	:	877-583-4033
Fax Number	:	561-935-9889

Provider Business Practice Location Address
First Line	:	101 N US HIGHWAY 1 STE 213
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-4262
Country	:	US
Telephone Number	:	877-583-4033
Fax Number	:	561-935-9889

Authorized Official
Title or Position	:	OWNER
Name	:	AMPARO CABRERA QUINTANA
Credential	:
Telephone Number	:	877-583-4033

Provider Enumeration Date	:	03/07/2019
Last Update Date	:	04/22/2020

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