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General NPI Number Information
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NPI Number | 1205452067
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Entity Type | Organization
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Legal Business Name | VIRA WELLNESS, LLC
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Dates
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Enumeration Date | 06/17/2020
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Last Update Date | 06/17/2020
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Provider Practice Location Address
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Address Line | 2429 HOLLYWOOD BLVD STE 300
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City | HOLLYWOOD
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State | FL
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Zip | 33020-6605
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Country | US
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Telephone | 954-669-1125
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Fax | 954-688-7010
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Provider Business Mailing Address
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Address Line | 2429 HOLLYWOOD BLVD STE 300
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City | HOLLYWOOD
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State | FL
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Zip | 33020-6605
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Country | US
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Telephone | 954-669-1125
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Fax | 954-688-7010
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Authorized Official
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Title or Position | OWNER
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Name | MR. CARLOS PROENZA
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Credential |
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Telephone | 954-669-1125
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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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 | 261QP2000X
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Taxonomy Name | Physical Therapy 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 | 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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