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General NPI Number Information
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NPI Number | 1912367384
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Entity Type | Organization
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Legal Business Name | KAISER WELLNESS CENTER
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Dates
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Enumeration Date | 02/29/2016
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Last Update Date | 05/24/2018
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Provider Practice Location Address
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Address Line | 1717 N FLAGLER DR SUITE #3
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City | WEST PALM BEACH
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State | FL
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Zip | 33407
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Country | US
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Telephone | 954-707-4640
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Fax |
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Provider Business Mailing Address
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Address Line | 1717 N FLAGLER DR SUITE #3
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City | WEST PALM BEACH
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State | FL
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Zip | 33407-6555
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MAHER SOUDAH
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Credential |
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Telephone | 614-772-0078
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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