Healthcare Provider Details

I. General information

NPI: 1174171797
Provider Name (Legal Business Name): HOLISTIC ELITE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2019
Last Update Date: 08/04/2022
Certification Date: 08/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3408 W 84TH ST SUITE 106
HIALEAH FL
33018
US

IV. Provider business mailing address

8060 NW 176 ST
HIALEAH FL
33015
US

V. Phone/Fax

Practice location:
  • Phone: 305-395-7007
  • Fax:
Mailing address:
  • Phone: 305-395-7007
  • Fax: 305-395-6600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARITZA TORRES
Title or Position: OWNER
Credential:
Phone: 305-395-7007