Healthcare Provider Details

I. General information

NPI: 1881501880
Provider Name (Legal Business Name): HOLISTIC HEALTH MEDICAL CENTER AND MED SPA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26381 S TAMIAMI TRL STE 116
BONITA SPRINGS FL
34134-7803
US

IV. Provider business mailing address

26381 S TAMIAMI TRL STE 116
BONITA SPRINGS FL
34134-7803
US

V. Phone/Fax

Practice location:
  • Phone: 239-777-0384
  • Fax:
Mailing address:
  • Phone: 239-777-0384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. JOEL PELISSIER
Title or Position: PARTNER
Credential: MD
Phone: 239-236-6130