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General NPI Number Information
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NPI Number | 1306394168
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Entity Type | Organization
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Legal Business Name | THE 5 ELEMENTS SPA & LONGEVITY CENTER
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Dates
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Enumeration Date | 09/21/2016
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Last Update Date | 09/21/2016
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Provider Practice Location Address
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Address Line | 2288 WILTON DRIVE
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City | WILTON MANORS
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State | FL
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Zip | 33305
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Country | US
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Telephone | 954-533-2604
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Fax |
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Provider Business Mailing Address
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Address Line | 2288 WILTON DRIVE
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City | WILTON MANORS
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State | FL
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Zip | 33305
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Country | US
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Telephone | 954-533-2604
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CATALINA RESTREPO
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Credential |
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Telephone | 305-607-2335
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | MM35287
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License Number State | FL
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