Healthcare Provider Details

I. General information

NPI: 1316713548
Provider Name (Legal Business Name): HEALTHY & WELLNESS COMMUNITY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2023
Last Update Date: 02/29/2024
Certification Date: 02/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 SW 22ND ST STE 420
MIAMI FL
33145-2784
US

IV. Provider business mailing address

1801 SW 22ND ST STE 420
MIAMI FL
33145-2784
US

V. Phone/Fax

Practice location:
  • Phone: 305-603-8517
  • Fax: 305-603-8666
Mailing address:
  • Phone: 305-603-8517
  • Fax: 305-603-8666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MARIA E GADEA
Title or Position: PRESIDENT
Credential: APRN
Phone: 786-222-6062