Healthcare Provider Details

I. General information

NPI: 1205127578
Provider Name (Legal Business Name): FLORIDA WELLNESS & REHAB CTR BILLING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2011
Last Update Date: 04/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 EAST 1ST AVE
HIALEAH FL
33010
US

IV. Provider business mailing address

51 EAST 1ST AVE
HIALEAH FL
33010
US

V. Phone/Fax

Practice location:
  • Phone: 305-888-5280
  • Fax: 305-888-5299
Mailing address:
  • Phone: 305-888-5280
  • Fax: 305-888-5299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License NumberCH6867
License Number StateFL

VIII. Authorized Official

Name: DR. MARK A CERECEDA
Title or Position: PRESIDENT
Credential: DC
Phone: 305-888-5280