Healthcare Provider Details

I. General information

NPI: 1770060493
Provider Name (Legal Business Name): OASIS WELLNESS CENTER OF FLORIDA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2018
Last Update Date: 07/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4410 W 16TH AVE STE 59
HIALEAH FL
33012-7194
US

IV. Provider business mailing address

4410 W 16TH AVE STE 59
HIALEAH FL
33012-7194
US

V. Phone/Fax

Practice location:
  • Phone: 305-824-8559
  • Fax: 305-824-8561
Mailing address:
  • Phone: 305-824-8559
  • Fax: 305-824-8561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MRS. YELENA INGUANZO
Title or Position: MANAGER
Credential: LMHC
Phone: 305-613-5125