Healthcare Provider Details

I. General information

NPI: 1285429985
Provider Name (Legal Business Name): NCC WELLNESS SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2025
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1886 SW 57TH AVE
MIAMI FL
33155-2139
US

IV. Provider business mailing address

1886 SW 57TH AVE
MIAMI FL
33155-2139
US

V. Phone/Fax

Practice location:
  • Phone: 786-263-8726
  • Fax:
Mailing address:
  • Phone: 305-791-9661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: YAIMA HURTADO SOTO
Title or Position: VICE PRESIDENT
Credential:
Phone: 786-263-8726