Healthcare Provider Details

I. General information

NPI: 1336436153
Provider Name (Legal Business Name): PERFECTED WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2011
Last Update Date: 09/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4889 SINCLAIR RD SUITE 112
COLUMBUS OH
43229-5432
US

IV. Provider business mailing address

4889 SINCLAIR RD SUITE 112
COLUMBUS OH
43229-5432
US

V. Phone/Fax

Practice location:
  • Phone: 614-537-5542
  • Fax:
Mailing address:
  • Phone: 614-537-5542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number34.003736
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number34.003736
License Number StateOH

VIII. Authorized Official

Name: DR. ROGER GARCIA
Title or Position: PRESIDENT
Credential: D.O.
Phone: 614-537-5542