Healthcare Provider Details

I. General information

NPI: 1255228086
Provider Name (Legal Business Name): OPAL OASIS INTEGRATIVE WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2025
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2820 NE 214TH ST STE 808
AVENTURA FL
33180-1270
US

IV. Provider business mailing address

2820 NE 214TH ST STE 808
AVENTURA FL
33180-1270
US

V. Phone/Fax

Practice location:
  • Phone: 305-482-1632
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ANGELICA MERLANO
Title or Position: OWNER/PHYSICIAN ASSISTANT
Credential: PA-C
Phone: 305-482-1632