Healthcare Provider Details

I. General information

NPI: 1669067344
Provider Name (Legal Business Name): A&C WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2021
Last Update Date: 03/05/2021
Certification Date: 03/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1748 W 56TH TER UNIT 410
HIALEAH FL
33012-2006
US

IV. Provider business mailing address

1748 W 56TH TER UNIT 410
HIALEAH FL
33012-2006
US

V. Phone/Fax

Practice location:
  • Phone: 786-319-8826
  • Fax:
Mailing address:
  • Phone: 786-319-8826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CARMEN M PEREZ SANTAMARIA
Title or Position: MANAGER
Credential:
Phone: 786-975-3069