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General NPI Number Information
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NPI Number | 1760933220
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Entity Type | Organization
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Legal Business Name | REAWAKENINGS WELLNESS CENTER
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Dates
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Enumeration Date | 10/20/2016
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 3600 RED RD 5TH FLOOR
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City | MIRAMAR
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State | FL
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Zip | 33025-6013
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Country | US
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Telephone | 954-544-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 3600 RED RD 5TH FLOOR
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City | MIRAMAR
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State | FL
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Zip | 33025-6013
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Country | US
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Telephone | 954-544-3000
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | JOE TORO
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Credential |
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Telephone | 954-544-3000
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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 | 0601
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License Number State | FL
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