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General NPI Number Information
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NPI Number | 1174289946
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Entity Type | Organization
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Legal Business Name | FLORIDA WELLNESS & REGENERATIVE MEDICINE, LLC
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Dates
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Enumeration Date | 11/16/2021
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Last Update Date | 03/30/2022
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Provider Practice Location Address
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Address Line | 7345 W SAND LAKE RD STE 301
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City | ORLANDO
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State | FL
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Zip | 32819-5281
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Country | US
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Telephone | 321-204-8237
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Fax | 833-957-2257
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Provider Business Mailing Address
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Address Line | 7345 W SAND LAKE RD STE 301
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City | ORLANDO
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State | FL
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Zip | 32819-5281
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Country | US
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Telephone | 321-204-8237
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Fax | 833-957-2257
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DIANA HUSSAIN
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Credential | MD
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Telephone | 321-204-8237
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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