Healthcare Provider Details

I. General information

NPI: 1932400900
Provider Name (Legal Business Name): ALLASSO WELLNESS COUNSELING, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2010
Last Update Date: 08/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1735 W 65TH ST
HIALEAH FL
33012-6111
US

IV. Provider business mailing address

1735 W 65TH ST
HIALEAH FL
33012-6111
US

V. Phone/Fax

Practice location:
  • Phone: 305-335-0707
  • Fax:
Mailing address:
  • Phone: 305-335-0707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSE LEOBARDO DIAZ
Title or Position: PRESIDENT
Credential:
Phone: 305-335-0707