Healthcare Provider Details

I. General information

NPI: 1609789445
Provider Name (Legal Business Name): HEALTH 100 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 WAGNER AVE
LEHIGH ACRES FL
33972-8720
US

IV. Provider business mailing address

1913 S MINTLE ST TRLR 42
AIRWAY HEIGHTS WA
99001-5262
US

V. Phone/Fax

Practice location:
  • Phone: 512-842-0359
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ANGEL OQUENDO PEREZ
Title or Position: MGR
Credential:
Phone: 512-842-0359