Healthcare Provider Details

I. General information

NPI: 1427981406
Provider Name (Legal Business Name): INTEGRATIVE PSYCHIATRY AND WHOLE BODY WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1779 HARBORSIDE CIR
WELLINGTON FL
33414-8068
US

IV. Provider business mailing address

1779 HARBORSIDE CIR
WELLINGTON FL
33414-8068
US

V. Phone/Fax

Practice location:
  • Phone: 561-670-0243
  • Fax:
Mailing address:
  • Phone: 561-670-0243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: HADRY CHARYLL DIAZ
Title or Position: OWNER
Credential: APRN FNP-C, PMHNP-BC
Phone: 561-670-0243