Healthcare Provider Details

I. General information

NPI: 1952920746
Provider Name (Legal Business Name): LITTLE HABANA WELLNESS CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2020
Last Update Date: 04/11/2020
Certification Date: 04/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

849 SW 1ST ST
MIAMI FL
33130-1207
US

IV. Provider business mailing address

849 SW 1ST ST
MIAMI FL
33130-1207
US

V. Phone/Fax

Practice location:
  • Phone: 786-353-9284
  • Fax: 786-817-2518
Mailing address:
  • Phone: 786-353-9284
  • Fax: 786-817-2518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LUIS NIETO
Title or Position: PRESIDENT
Credential:
Phone: 786-570-3900