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General NPI Number Information
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NPI Number | 1013456805
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Entity Type | Organization
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Legal Business Name | DE LA ROSA WELLNESS CENTER, LLC
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Dates
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Enumeration Date | 02/14/2017
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Last Update Date | 02/20/2017
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Provider Practice Location Address
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Address Line | 7392 NW 35TH TER STE 310
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City | MIAMI
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State | FL
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Zip | 33122-1260
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Country | US
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Telephone | 786-360-2046
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Fax |
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Provider Business Mailing Address
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Address Line | 7392 NW 35TH TER STE 310
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City | MIAMI
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State | FL
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Zip | 33122-1260
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Country | US
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Telephone | 786-360-2046
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MARIO DE LA ROSA
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Credential |
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Telephone | 786-360-2046
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | MA35823
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | MA35823
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | MA35823
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License Number State | FL
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