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General NPI Number Information
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NPI Number | 1790335164
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Entity Type | Organization
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Legal Business Name | CUSTOMIZED WELLNESS, LLC
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Dates
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Enumeration Date | 09/17/2019
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Last Update Date | 09/17/2019
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Provider Practice Location Address
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Address Line | 131 W CENTER AVENUE
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City | SEBRING
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State | FL
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Zip | 33870
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Country | US
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Telephone | 863-658-1764
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Fax | 855-847-8646
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Provider Business Mailing Address
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Address Line | 131 W CENTER AVENUE
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City | SEBRING
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State | FL
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Zip | 33870
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Country | US
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Telephone | 863-658-1764
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Fax | 855-847-8646
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | AMANDA C LUCERO
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Credential | APRN
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Telephone | 863-658-1764
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number |
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License Number State |
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