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General NPI Number Information
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NPI Number | 1952920746
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Entity Type | Organization
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Legal Business Name | LITTLE HABANA WELLNESS CENTER INC
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Dates
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Enumeration Date | 04/11/2020
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Last Update Date | 04/11/2020
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Provider Practice Location Address
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Address Line | 849 SW 1ST ST
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City | MIAMI
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State | FL
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Zip | 33130-1207
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Country | US
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Telephone | 786-353-9284
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Fax | 786-817-2518
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Provider Business Mailing Address
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Address Line | 849 SW 1ST ST
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City | MIAMI
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State | FL
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Zip | 33130-1207
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Country | US
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Telephone | 786-353-9284
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Fax | 786-817-2518
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Authorized Official
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Title or Position | PRESIDENT
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Name | LUIS NIETO
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Credential |
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Telephone | 786-570-3900
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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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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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