Healthcare Provider Details

I. General information

NPI: 1437972049
Provider Name (Legal Business Name): LA BELLA VITA WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2024
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14400 SW 79TH CT
PALMETTO BAY FL
33158-2019
US

IV. Provider business mailing address

14400 SW 79TH CT
PALMETTO BAY FL
33158-2019
US

V. Phone/Fax

Practice location:
  • Phone: 305-510-0111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: YAIMARA CRUZ
Title or Position: PRESIDENT
Credential: APRN
Phone: 305-510-0111