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General NPI Number Information
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NPI Number | 1437798139
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Entity Type | Organization
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Legal Business Name | FAMILY WELLNESS AND AESTHETIC CENTER LLC
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Dates
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Enumeration Date | 12/27/2019
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Last Update Date | 02/18/2025
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Provider Practice Location Address
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Address Line | 7800 W OAKLAND PARK BLVD STE B105
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City | SUNRISE
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State | FL
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Zip | 33351-6741
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Country | US
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Telephone | 954-890-3902
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Fax | 954-999-0230
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Provider Business Mailing Address
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Address Line | 7800 W OAKLAND PARK BLVD STE B105
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City | SUNRISE
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State | FL
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Zip | 33351-6741
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Country | US
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Telephone | 954-890-3892
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Fax | 954-999-0230
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Authorized Official
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Title or Position | PRESIDENT
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Name | FANUEL DORILAS
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Credential |
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Telephone | 954-478-2041
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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