Healthcare Provider Details

I. General information

NPI: 1306699343
Provider Name (Legal Business Name): TOTAL HEALTH AND WELLNESS SPA CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2024
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13385 MEMORIAL HWY
NORTH MIAMI FL
33161-3939
US

IV. Provider business mailing address

13385 MEMORIAL HWY
NORTH MIAMI FL
33161-3939
US

V. Phone/Fax

Practice location:
  • Phone: 305-200-5767
  • Fax:
Mailing address:
  • Phone: 305-200-5767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RODNEY NOEL
Title or Position: OWNER
Credential:
Phone: 754-232-3500