Healthcare Provider Details

I. General information

NPI: 1093254716
Provider Name (Legal Business Name): HATHOR WELLCARE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2017
Last Update Date: 01/25/2023
Certification Date: 01/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13335 SW 124TH ST STE 206
MIAMI FL
33186-7515
US

IV. Provider business mailing address

13335 SW 124TH ST STE 206
MIAMI FL
33186-7515
US

V. Phone/Fax

Practice location:
  • Phone: 786-429-1495
  • Fax: 786-227-6780
Mailing address:
  • Phone: 786-429-1495
  • Fax: 786-227-6780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. PEDRO RAFAEL FAJARDO POMPA
Title or Position: OWNER/PRESIDENT
Credential: MASSAGE THERAPIST
Phone: 786-452-1751