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General NPI Number Information
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NPI Number | 1174710289
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Entity Type | Organization
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Legal Business Name | WELLNESS CENTER OF NMB
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Dates
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Enumeration Date | 10/02/2007
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Last Update Date | 01/15/2019
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Provider Practice Location Address
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Address Line | 1920 E HALLANDALE BEACH BLVD STE 508
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-4723
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Country | US
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Telephone | 305-244-7993
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Fax | 305-993-4832
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Provider Business Mailing Address
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Address Line | 1920 E HALLANDALE BEACH BLVD STE 508
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-4723
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Country | US
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Telephone | 305-244-7993
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Fax | 305-993-4832
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Authorized Official
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Title or Position | PRESIDENT
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Name | RAYMOND V FAILER
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Credential | MD
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Telephone | 786-274-1990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | OS0001920
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License Number State | FL
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