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General NPI Number Information
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NPI Number | 1699097295
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Entity Type | Organization
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Legal Business Name | SUNSHINE WELLNESS CLINIC CORP
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Dates
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Enumeration Date | 02/23/2010
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Last Update Date | 05/28/2014
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Provider Practice Location Address
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Address Line | 3970 W FLAGLER ST STE102
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City | CORAL GABLES
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State | FL
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Zip | 33134-1642
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Country | US
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Telephone | 786-362-5105
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Fax | 786-362-5436
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Provider Business Mailing Address
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Address Line | 3970 W FLAGLER ST STE102
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City | CORAL GABLES
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State | FL
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Zip | 33134-1642
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Country | US
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Telephone | 786-362-5105
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Fax | 786-362-5436
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. VIOLETA OTERO
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Credential |
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Telephone | 786-362-5436
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MM24858
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License Number State | FL
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