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General NPI Number Information
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NPI Number | 1942513213
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Entity Type | Organization
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Legal Business Name | HEALTH 1 WELLNESS CENTER
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Dates
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Enumeration Date | 07/15/2010
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Last Update Date | 07/15/2010
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Provider Practice Location Address
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Address Line | 700 IVES DAIRY RD
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City | MIAMI
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State | FL
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Zip | 33179-2425
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Country | US
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Telephone | 305-690-9784
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Fax | 305-690-9788
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Provider Business Mailing Address
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Address Line | 700 IVES DAIRY RD
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City | MIAMI
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State | FL
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Zip | 33179
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Country | US
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Telephone | 305-690-9784
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Fax | 305-690-9788
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Authorized Official
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Title or Position | CEO
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Name | MR. MICHAEL JOHN GOULET
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Credential | BUSINESS OWNER
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Telephone | 305-690-9784
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | OS 9465
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License Number State | FL
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