Healthcare Provider Details

I. General information

NPI: 1225651136
Provider Name (Legal Business Name): WELLCARE CLINICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2020
Last Update Date: 07/07/2020
Certification Date: 07/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4835 HOLLYWOOD BLVD
HOLLYWOOD FL
33021-6548
US

IV. Provider business mailing address

4701 PIERCE ST
HOLLYWOOD FL
33021-5807
US

V. Phone/Fax

Practice location:
  • Phone: 954-908-9550
  • Fax:
Mailing address:
  • Phone: 713-703-5255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code202C00000X
TaxonomyIndependent Medical Examiner Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. AURORA LUNA
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 713-703-5255