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General NPI Number Information
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NPI Number | 1003109281
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Entity Type | Organization
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Legal Business Name | ST. CHARLES HEALTH & WELLNESS, INC.
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Dates
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Enumeration Date | 05/22/2011
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Last Update Date | 05/22/2011
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Provider Practice Location Address
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Address Line | 15260 SW 280TH ST SUITE 105
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City | HOMESTEAD
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State | FL
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Zip | 33032-8185
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Country | US
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Telephone | 305-242-5331
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Fax | 305-242-5334
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Provider Business Mailing Address
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Address Line | 15260 SW 280TH ST SUITE 105
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City | HOMESTEAD
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State | FL
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Zip | 33032-8185
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Country | US
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Telephone | 305-242-5331
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Fax | 305-242-5334
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. CARLOS M GONZALEZ
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Credential | D.C.
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Telephone | 305-242-5331
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | CH6724
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License Number State | FL
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