Healthcare Provider Details

I. General information

NPI: 1912459272
Provider Name (Legal Business Name): ENDOCRINE HEALTH AND WELLNESS OF SOUTH FLORIDA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2016
Last Update Date: 05/05/2020
Certification Date: 05/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12060 SW 129TH CT STE 205
MIAMI FL
33186-4582
US

IV. Provider business mailing address

14720 JACKSON ST
MIAMI FL
33176-7450
US

V. Phone/Fax

Practice location:
  • Phone: 786-592-2744
  • Fax: 949-404-6517
Mailing address:
  • Phone: 305-951-2152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberOS11351
License Number StateFL

VIII. Authorized Official

Name: THERESA MARIA COLLIER
Title or Position: OWNER
Credential: D.O.
Phone: 305-951-2152