Healthcare Provider Details

I. General information

NPI: 1023948411
Provider Name (Legal Business Name): REDEFINED HEALTH AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4508 HARVEST RD
TEMPLE HILLS MD
20748-3612
US

IV. Provider business mailing address

4508 HARVEST RD
TEMPLE HILLS MD
20748-3612
US

V. Phone/Fax

Practice location:
  • Phone: 202-945-2893
  • Fax: 240-628-7472
Mailing address:
  • Phone: 202-945-2893
  • Fax: 240-628-7472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. REYNALDO DE LA CRUZ
Title or Position: NURSE PRACTITIONER
Credential: FNP-C
Phone: 202-945-2893