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General NPI Number Information
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NPI Number | 1134888621
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Entity Type | Organization
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Legal Business Name | FAMILY WELLNESS CLINIC LLP
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Dates
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Enumeration Date | 12/11/2021
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Last Update Date | 01/10/2025
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Provider Practice Location Address
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Address Line | 7236 STATE ROAD 52 STE 13
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City | HUDSON
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State | FL
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Zip | 34667-6749
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Country | US
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Telephone | 727-233-6084
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Fax |
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Provider Business Mailing Address
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Address Line | 7236 STATE ROAD 52 STE 13
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City | HUDSON
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State | FL
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Zip | 34667-6749
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Country | US
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Telephone | 727-233-6084
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | KAYODE BALOGUN
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Credential |
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Telephone | 862-216-2617
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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