Healthcare Provider Details

I. General information

NPI: 1346002763
Provider Name (Legal Business Name): GLOWU HOLDINGS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2024
Last Update Date: 02/12/2024
Certification Date: 02/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 NW 20TH ST
BOCA RATON FL
33431-7966
US

IV. Provider business mailing address

141 NW 20TH ST
BOCA RATON FL
33431-7966
US

V. Phone/Fax

Practice location:
  • Phone: 267-969-1493
  • Fax:
Mailing address:
  • Phone: 267-969-1493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SCOTT WILLIS
Title or Position: MEDICAL
Credential: MD
Phone: 754-242-1876