Healthcare Provider Details

I. General information

NPI: 1942513213
Provider Name (Legal Business Name): HEALTH 1 WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2010
Last Update Date: 07/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 IVES DAIRY RD
MIAMI FL
33179-2425
US

IV. Provider business mailing address

700 IVES DAIRY RD
MIAMI FL
33179
US

V. Phone/Fax

Practice location:
  • Phone: 305-690-9784
  • Fax: 305-690-9788
Mailing address:
  • Phone: 305-690-9784
  • Fax: 305-690-9788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberOS 9465
License Number StateFL

VIII. Authorized Official

Name: MR. MICHAEL JOHN GOULET
Title or Position: CEO
Credential: BUSINESS OWNER
Phone: 305-690-9784