Healthcare Provider Details

I. General information

NPI: 1417558651
Provider Name (Legal Business Name): ECLIPSE WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

3015 S CONGRESS AVE STE 7
PALM SPRINGS FL
33461-2111
US

IV. Provider business mailing address

3015 S CONGRESS AVE STE 7
PALM SPRINGS FL
33461-2111
US

V. Phone/Fax

Practice location:
  • Phone: 561-623-7775
  • Fax:
Mailing address:
  • Phone: 561-623-7775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JANETTE ALFONSO
Title or Position: ELECTROLOGIST
Credential: ELECTROLOGIST
Phone: 561-623-7775