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General NPI Number Information
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NPI Number | 1326508458
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Entity Type | Organization
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Legal Business Name | WELLNESS& REJUVINATION CENTRE, P.A.
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Dates
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Enumeration Date | 03/24/2019
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Last Update Date | 03/24/2019
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Provider Practice Location Address
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Address Line | 270 NW PEACOCK BLVD STE 114
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City | PORT ST LUCIE
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State | FL
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Zip | 34986-1602
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Country | US
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Telephone | 772-600-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 270 NW PEACOCK BLVD STE 114
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City | PORT ST LUCIE
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State | FL
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Zip | 34986-1602
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Country | US
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Telephone | 772-600-1000
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Fax |
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Authorized Official
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Title or Position | PD
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Name | BERNIER LAUREDAN
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Credential | MD
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Telephone | 908-265-6199
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number |
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License Number State |
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