Healthcare Provider Details

I. General information

NPI: 1376878132
Provider Name (Legal Business Name): FLORIDA HEALTH & WELLNESS CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2009
Last Update Date: 10/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15200 JOG RD STE A-3
DELRAY BEACH FL
33446-1247
US

IV. Provider business mailing address

15200 JOG RD STE A-3
DELRAY BEACH FL
33446-1247
US

V. Phone/Fax

Practice location:
  • Phone: 561-498-7998
  • Fax: 561-498-7993
Mailing address:
  • Phone: 561-498-7998
  • Fax: 561-498-7993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberME37959
License Number StateZZ
# 2
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberME74889
License Number StateTN

VIII. Authorized Official

Name: BRUCE S GREEN
Title or Position: PRESIDENT
Credential:
Phone: 561-498-7998