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General NPI Number Information
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NPI Number | 1104291756
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Entity Type | Organization
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Legal Business Name | THE WELLNESS GROUP OF TAMPA, LLC
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Dates
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Enumeration Date | 12/08/2015
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Last Update Date | 09/22/2016
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Provider Practice Location Address
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Address Line | 1910 ORIENT RD
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City | TAMPA
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State | FL
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Zip | 33619-3354
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Country | US
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Telephone | 813-701-1234
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Fax | 813-630-4670
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Provider Business Mailing Address
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Address Line | 1910 ORIENT RD
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City | TAMPA
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State | FL
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Zip | 33619-3354
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Country | US
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Telephone | 813-701-1234
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Fax | 813-630-4670
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | MR. FRANKIE ESTEBAN VALLE
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Credential | LMHC
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Telephone | 813-701-1234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | ME85148
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License Number State | FL
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