Healthcare Provider Details

I. General information

NPI: 1073105227
Provider Name (Legal Business Name): LABISTE MEDICAL AND WELLNESS CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2021
Last Update Date: 05/05/2022
Certification Date: 05/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 W 20TH AVE STE 315
HIALEAH FL
33016-1811
US

IV. Provider business mailing address

1780 SW 127TH TER
MIRAMAR FL
33027-2537
US

V. Phone/Fax

Practice location:
  • Phone: 954-470-4609
  • Fax: 954-516-0612
Mailing address:
  • Phone: 305-322-6357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. LAYDA C. LABISTE
Title or Position: OWNER
Credential: ARNP
Phone: 954-470-4609