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NPI Code Detail

MEDICARE: UNITED WELLNESS CENTER LLC

MEDICARE: UNITED WELLNESS CENTER 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
1103K00000XBehavior Analyst

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1174299622
Entity Type Code : Organization
Provider Name (Legal Business Name) : UNITED WELLNESS CENTER LLC
Provider Business Mailing Address
First Line : 6250 HAZELTINE NATIONAL DR STE 102
Second Line :
City : ORLANDO
State : FL
Zip : 32822-5102
Country : US
Telephone Number : 407-237-9955
Fax Number :
Provider Business Practice Location Address
First Line : 6250 HAZELTINE NATIONAL DR STE 102
Second Line :
City : ORLANDO
State : FL
Zip : 32822-5102
Country : US
Telephone Number : 407-237-9955
Fax Number :
Authorized Official
Title or Position : MBR
Name : LOURDES BASTARDO
Credential :
Telephone Number : 178-621-2684
Provider Enumeration Date : 08/16/2021
Last Update Date : 08/16/2021

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Directions to “UNITED WELLNESS CENTER LLC ” Practice Location

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