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General NPI Number Information
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NPI Number | 1144770686
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Entity Type | Organization
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Legal Business Name | THE PALMS WELLNESS CENTER
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Dates
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Enumeration Date | 10/07/2016
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Last Update Date | 10/07/2016
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Provider Practice Location Address
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Address Line | 10570 S US HIGHWAY 1 SUITE 102
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34952-5606
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Country | US
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Telephone | 772-828-6992
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Fax |
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Provider Business Mailing Address
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Address Line | 10570 S US HIGHWAY 1 SUITE 102
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34952-5606
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Country | US
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Telephone | 772-828-6992
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. BETH IRIS HERNANDEZ
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Credential |
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Telephone | 772-828-6992
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | ME83014
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License Number State | FL
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