Healthcare Provider Details

I. General information

NPI: 1003306028
Provider Name (Legal Business Name): HOLISTIC HEALING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2018
Last Update Date: 05/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2999 NE 191ST ST STE 406
AVENTURA FL
33180
US

IV. Provider business mailing address

2999 NE 191ST ST STE 406
AVENTURA FL
33180-3116
US

V. Phone/Fax

Practice location:
  • Phone: 305-949-9828
  • Fax: 305-949-1447
Mailing address:
  • Phone: 305-949-9828
  • Fax: 305-949-1447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: MR. MARCELO MARTINEZ CUERVO
Title or Position: MANAGER MEMBER
Credential:
Phone: 305-949-9828