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General NPI Number Information
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NPI Number | 1306443320
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Entity Type | Organization
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Legal Business Name | BODYWINS LLC
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Dates
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Enumeration Date | 10/02/2020
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Last Update Date | 04/30/2021
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Provider Practice Location Address
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Address Line | 3221 NW 10TH TER STE 508
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City | FORT LAUDERDALE
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State | FL
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Zip | 33309-5942
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Country | US
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Telephone | 954-667-7908
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Fax |
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Provider Business Mailing Address
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Address Line | 2930 NW 26TH AVE
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City | BOCA RATON
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State | FL
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Zip | 33434-3664
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Country | US
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Telephone | 954-667-7908
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT & CHIEF OF STAFF
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Name | MARIA ELISE LASSO
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Credential | JD
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Telephone | 954-951-1539
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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