Healthcare Provider Details

I. General information

NPI: 1730097320
Provider Name (Legal Business Name): HYDRAVIT HEALTH AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 COW PEN RD STE 240
MIAMI LAKES FL
33014-7619
US

IV. Provider business mailing address

6600 COW PEN RD STE 240
MIAMI LAKES FL
33014-7619
US

V. Phone/Fax

Practice location:
  • Phone: 833-493-7288
  • Fax: 754-218-0781
Mailing address:
  • Phone: 833-493-7288
  • Fax: 754-218-0781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MARSELLA JIMENO-PERALTA JR.
Title or Position: MANAGING MEMBER
Credential: APRN, FNP-C
Phone: 754-610-7728