Healthcare Provider Details

I. General information

NPI: 1427509678
Provider Name (Legal Business Name): OASIS RECOVERY AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2016
Last Update Date: 10/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7350 LAKE WORTH RD
LAKE WORTH FL
33467-2529
US

IV. Provider business mailing address

7350 LAKE WORTH RD
LAKE WORTH FL
33467-2529
US

V. Phone/Fax

Practice location:
  • Phone: 954-415-8781
  • Fax:
Mailing address:
  • Phone: 954-415-8781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: ANGELA IACULLO
Title or Position: BILLING
Credential:
Phone: 954-415-8781