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General NPI Number Information
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NPI Number | 1356964498
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Entity Type | Organization
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Legal Business Name | SANTA FE WELLNESS CENTER LLC
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Dates
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Enumeration Date | 05/23/2020
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Last Update Date | 05/23/2020
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Provider Practice Location Address
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Address Line | 7360 SW 24TH ST STE 17A
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City | MIAMI
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State | FL
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Zip | 33155-1482
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Country | US
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Telephone | 786-570-3130
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Fax |
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Provider Business Mailing Address
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Address Line | 7360 SW 24TH ST STE 17A
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City | MIAMI
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State | FL
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Zip | 33155-1482
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Country | US
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Telephone | 786-570-3130
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Fax |
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Authorized Official
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Title or Position | MBR
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Name | IDELKIS GONZALEZ
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Credential |
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Telephone | 305-799-0183
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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