Healthcare Provider Details

I. General information

NPI: 1437585866
Provider Name (Legal Business Name): THE WONDER SPROUT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2013
Last Update Date: 09/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29629 S DIXIE HWY
HOMESTEAD FL
33033-3320
US

IV. Provider business mailing address

29629 S DIXIE HWY
HOMESTEAD FL
33033-3320
US

V. Phone/Fax

Practice location:
  • Phone: 786-444-6003
  • Fax:
Mailing address:
  • Phone: 786-444-6003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102X00000X
TaxonomyPoetry Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. JESUS CRUZ
Title or Position: PRESIDENT
Credential:
Phone: 786-444-6003