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General NPI Number Information
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NPI Number | 1285429985
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Entity Type | Organization
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Legal Business Name | NCC WELLNESS SERVICES LLC
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Dates
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Enumeration Date | 04/12/2025
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Last Update Date | 01/06/2026
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Provider Practice Location Address
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Address Line | 1886 SW 57TH AVE
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City | MIAMI
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State | FL
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Zip | 33155-2139
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Country | US
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Telephone | 786-263-8726
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Fax |
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Provider Business Mailing Address
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Address Line | 1886 SW 57TH AVE
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City | MIAMI
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State | FL
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Zip | 33155-2139
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Country | US
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Telephone | 305-791-9661
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | YAIMA HURTADO SOTO
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Credential |
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Telephone | 786-263-8726
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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