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General NPI Number Information
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NPI Number | 1730097320
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Entity Type | Organization
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Legal Business Name | HYDRAVIT HEALTH AND WELLNESS LLC
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Dates
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Enumeration Date | 09/01/2026
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Last Update Date | 09/01/2026
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Provider Practice Location Address
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Address Line | 6600 COW PEN RD STE 240
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City | MIAMI LAKES
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State | FL
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Zip | 33014-7619
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Country | US
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Telephone | 833-493-7288
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Fax | 754-218-0781
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Provider Business Mailing Address
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Address Line | 6600 COW PEN RD STE 240
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City | MIAMI LAKES
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State | FL
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Zip | 33014-7619
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Country | US
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Telephone | 833-493-7288
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Fax | 754-218-0781
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MARSELLA JIMENO-PERALTA JR.
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Credential | APRN, FNP-C
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Telephone | 754-610-7728
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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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