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General NPI Number Information
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NPI Number | 1235495532
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Entity Type | Organization
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Legal Business Name | TOTAL BODY WELLNESS CENTER OF MIAMI LAKES
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Dates
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Enumeration Date | 04/11/2012
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Last Update Date | 04/11/2012
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Provider Practice Location Address
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Address Line | 18400 NW 75TH PL STE 119
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City | HIALEAH
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State | FL
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Zip | 33015-2955
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Country | US
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Telephone | 786-235-9096
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Fax |
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Provider Business Mailing Address
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Address Line | 18520 NW 67TH AVE STE 278
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City | HIALEAH
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State | FL
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Zip | 33015-3302
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Country | US
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Telephone | 786-235-9096
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | NILAJA BIGGS
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Credential |
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Telephone | 954-533-7614
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS7686
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License Number State | FL
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