Healthcare Provider Details

I. General information

NPI: 1306227988
Provider Name (Legal Business Name): ASANA WELLNESS CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2015
Last Update Date: 06/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9119 MERRILL RD SUITE # 32
JACKSONVILLE FL
32225-4312
US

IV. Provider business mailing address

201 N KROME AVE SUITE # 210
HOMESTEAD FL
33030-6010
US

V. Phone/Fax

Practice location:
  • Phone: 800-332-7262
  • Fax:
Mailing address:
  • Phone: 305-246-0056
  • Fax: 305-246-0093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. REYNALDO PEREZ
Title or Position: MANAGING MEMBER
Credential: D.C.
Phone: 800-332-7262