=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124576830
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE WELLNESS INSTITUTE OF THE AMERICAS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/12/2016
-----------------------------------------------------
Last Update Date | 09/12/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 888 BRICKELL AVE SUITE 600
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33131-2913
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-371-7172
-----------------------------------------------------
Fax | 786-221-4435
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 888 BRICKELL AVE SUITE 600
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33131-2913
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-371-7172
-----------------------------------------------------
Fax | 786-221-4435
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD/OWNER
-----------------------------------------------------
Name | DR. JUAN J REMOS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 305-371-7172
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | ME52943
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------