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General NPI Number Information
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NPI Number | 1598051971
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Entity Type | Organization
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Legal Business Name | NIKKEN WELLNESS CENTER INC
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Dates
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Enumeration Date | 06/23/2011
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Last Update Date | 06/23/2011
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Provider Practice Location Address
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Address Line | 901 S STATE ROAD 7 430
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City | HOLLYWOOD
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State | FL
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Zip | 33023-6700
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Country | US
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Telephone | 954-239-8528
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Fax | 954-239-8845
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Provider Business Mailing Address
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Address Line | 901 S STATE ROAD 7 430
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City | HOLLYWOOD
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State | FL
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Zip | 33023-6700
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Country | US
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Telephone | 954-239-8528
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Fax | 954-239-8845
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Authorized Official
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Title or Position | OWNER
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Name | MR. HERNANDO FERNANDEZ
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Credential | MA 61484
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Telephone | 954-239-8528
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | MA61484
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License Number State | FL
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