Healthcare Provider Details

I. General information

NPI: 1578787453
Provider Name (Legal Business Name): FLORIDA WELLNESS & REHABILITATION CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 N KROME AVE
HOMESTEAD FL
33030-6018
US

IV. Provider business mailing address

207 N KROME AVE
HOMESTEAD FL
33030-6018
US

V. Phone/Fax

Practice location:
  • Phone: 305-246-0056
  • Fax: 305-246-0093
Mailing address:
  • Phone: 305-246-0056
  • Fax: 305-246-0093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK A CERECEDA
Title or Position: PRESIDENT
Credential: D.C., P.A.
Phone: 305-246-0056