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General NPI Number Information
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NPI Number | 1982572053
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Entity Type | Organization
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Legal Business Name | LAKES HEALTHCARE & WELLNESS
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Dates
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Enumeration Date | 10/29/2025
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Last Update Date | 10/29/2025
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Provider Practice Location Address
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Address Line | 8205 COMMERCE WAY STE 125
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City | MIAMI LAKES
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State | FL
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Zip | 33016-1668
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Country | US
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Telephone | 786-261-9628
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Fax | 305-827-5545
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Provider Business Mailing Address
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Address Line | 8205 COMMERCE WAY STE 125
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City | MIAMI LAKES
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State | FL
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Zip | 33016-1668
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Country | US
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Telephone | 786-261-9628
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Fax | 305-827-5545
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Authorized Official
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Title or Position | CEO
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Name | MS. SAMANTHA BOUZA
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Credential | CEO
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Telephone | 786-261-9628
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083T0002X
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Taxonomy Name | Medical Toxicology (Preventive Medicine) Physician
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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 | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 163WW0101X
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Taxonomy Name | Ambulatory Women's Health Care Registered Nurse
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License Number |
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License Number State |
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