Healthcare Provider Details

I. General information

NPI: 1053951970
Provider Name (Legal Business Name): WELLNESS PHYSICIANS GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2020
Last Update Date: 01/08/2020
Certification Date: 01/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 W SAMPLE RD BLDG 4
POMPANO BEACH FL
33073-3081
US

IV. Provider business mailing address

8050 N UNIVERSITY DR STE 207
TAMARAC FL
33321-2102
US

V. Phone/Fax

Practice location:
  • Phone: 954-905-6225
  • Fax:
Mailing address:
  • Phone: 954-905-6225
  • Fax: 954-737-1221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: JAYESH DAVE
Title or Position: CEO
Credential:
Phone: 954-678-0078