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General NPI Number Information
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NPI Number | 1972210508
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Entity Type | Organization
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Legal Business Name | PEARL ROSE WELLNESS, INC.
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Dates
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Enumeration Date | 11/02/2022
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Last Update Date | 06/02/2023
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Provider Practice Location Address
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Address Line | 1463 OAKFIELD DR STE 132
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City | BRANDON
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State | FL
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Zip | 33511-0802
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Country | US
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Telephone | 813-409-3425
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Fax | 813-409-3427
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Provider Business Mailing Address
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Address Line | 1463 OAKFIELD DR STE 132
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City | BRANDON
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State | FL
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Zip | 33511-0802
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Country | US
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Telephone | 813-409-3425
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Fax | 813-409-3427
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Authorized Official
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Title or Position | PRESIDENT/ OPERATION MANAGER
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Name | EDNA CARRASCO
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Credential |
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Telephone | 813-409-3425
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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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 | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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