Healthcare Provider Details

I. General information

NPI: 1497675466
Provider Name (Legal Business Name): BIENESTAR HEALTH CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4030 WAVING HICKORY BLVD
SAINT CLOUD FL
34772-9568
US

IV. Provider business mailing address

4030 WAVING HICKORY BLVD
SAINT CLOUD FL
34772-9568
US

V. Phone/Fax

Practice location:
  • Phone: 787-980-0466
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: NORBERTO RIOS MENDEZ
Title or Position: MANAGING MEMBER
Credential: FNP-BC
Phone: 787-980-0466