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General NPI Number Information
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NPI Number | 1669067344
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Entity Type | Organization
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Legal Business Name | A&C WELLNESS LLC
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Dates
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Enumeration Date | 03/04/2021
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Last Update Date | 03/05/2021
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Provider Practice Location Address
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Address Line | 1748 W 56TH TER UNIT 410
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City | HIALEAH
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State | FL
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Zip | 33012-2006
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Country | US
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Telephone | 786-319-8826
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Fax |
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Provider Business Mailing Address
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Address Line | 1748 W 56TH TER UNIT 410
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City | HIALEAH
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State | FL
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Zip | 33012-2006
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Country | US
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Telephone | 786-319-8826
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | CARMEN M PEREZ SANTAMARIA
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Credential |
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Telephone | 786-975-3069
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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