Healthcare Provider Details
I. General information
NPI: 1639921984
Provider Name (Legal Business Name): ALORA HEALTH, WELLNESS & AESTHETICS
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 04/02/2024
Last Update Date: 04/02/2024
Certification Date: 04/02/2024
Deactivation Date:
Reactivation Date:
III. Provider practice location address
5720 W 1ST SQ SW
VERO BEACH FL
32968-2256
US
IV. Provider business mailing address
5720 W 1ST SQ SW
VERO BEACH FL
32968-2256
US
V. Phone/Fax
- Phone: 614-556-8886
- Fax: 361-360-6589
- Phone: 614-556-8886
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207Q00000X |
| Taxonomy | Family Medicine Physician |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207VG0400X |
| Taxonomy | Gynecology Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
CHARISSA
WRIGHT
Title or Position: APRN
Credential: APRN
Phone: 614-556-8886