Healthcare Provider Details

I. General information

NPI: 1336996735
Provider Name (Legal Business Name): MANRESA HEALTH & WELLNESS CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2024
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3625 NW 82ND AVE STE 400K
DORAL FL
33166-7602
US

IV. Provider business mailing address

1402 W 42ND PL
HIALEAH FL
33012-7610
US

V. Phone/Fax

Practice location:
  • Phone: 786-299-7223
  • Fax:
Mailing address:
  • Phone: 786-299-7223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: VIVIANA MANRESA
Title or Position: PRESIDENT
Credential: NP
Phone: 786-299-7223