Healthcare Provider Details

I. General information

NPI: 1598051708
Provider Name (Legal Business Name): WOMEN'S WELLNESS CENTER, PROF. L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2011
Last Update Date: 07/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2390 HAWAII AVE SW
HURON SD
57350-4316
US

IV. Provider business mailing address

142 3RD ST SE
HURON SD
57350-2502
US

V. Phone/Fax

Practice location:
  • Phone: 612-578-4374
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SARA CASTELLANOS
Title or Position: MANAGING MEMBER/OWNER
Credential: DO
Phone: 612-578-4374