Healthcare Provider Details

I. General information

NPI: 1679110555
Provider Name (Legal Business Name): AZUL WELLNESS CENTER, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2019
Last Update Date: 12/10/2019
Certification Date: 12/10/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8888 SW 131ST CT APT 309
MIAMI FL
33186-1765
US

IV. Provider business mailing address

8888 SW 131ST CT APT 309
MIAMI FL
33186-1765
US

V. Phone/Fax

Practice location:
  • Phone: 954-702-3074
  • Fax:
Mailing address:
  • Phone: 954-702-3074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NADJA ATKINSON
Title or Position: CEO
Credential:
Phone: 954-702-3074