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General NPI Number Information
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NPI Number | 1417558651
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Entity Type | Organization
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Legal Business Name | ECLIPSE WELLNESS CENTER
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Dates
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Enumeration Date | 11/04/2020
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Last Update Date | 11/04/2020
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Provider Practice Location Address
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Address Line | 3015 S CONGRESS AVE STE 7
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City | PALM SPRINGS
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State | FL
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Zip | 33461-2111
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Country | US
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Telephone | 561-623-7775
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Fax |
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Provider Business Mailing Address
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Address Line | 3015 S CONGRESS AVE STE 7
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City | PALM SPRINGS
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State | FL
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Zip | 33461-2111
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Country | US
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Telephone | 561-623-7775
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Fax |
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Authorized Official
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Title or Position | ELECTROLOGIST
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Name | JANETTE ALFONSO
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Credential | ELECTROLOGIST
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Telephone | 561-623-7775
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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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 | 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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