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General NPI Number Information
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NPI Number | 1770060493
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Entity Type | Organization
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Legal Business Name | OASIS WELLNESS CENTER OF FLORIDA, LLC
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Dates
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Enumeration Date | 07/25/2018
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Last Update Date | 07/25/2018
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Provider Practice Location Address
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Address Line | 4410 W 16TH AVE STE 59
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City | HIALEAH
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State | FL
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Zip | 33012-7194
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Country | US
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Telephone | 305-824-8559
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Fax | 305-824-8561
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Provider Business Mailing Address
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Address Line | 4410 W 16TH AVE STE 59
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City | HIALEAH
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State | FL
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Zip | 33012-7194
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Country | US
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Telephone | 305-824-8559
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Fax | 305-824-8561
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. YELENA INGUANZO
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Credential | LMHC
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Telephone | 305-613-5125
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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