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General NPI Number Information
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NPI Number | 1992188999
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Entity Type | Organization
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Legal Business Name | EL DORADO WELLNESS CENTER PLLC
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Dates
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Enumeration Date | 07/08/2015
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Last Update Date | 09/01/2015
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Provider Practice Location Address
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Address Line | 431 THOMPSON AVE SUITE B
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City | EL DORADO
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State | AR
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Zip | 71730-4553
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Country | US
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Telephone | 870-639-8128
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Fax | 870-639-8129
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Provider Business Mailing Address
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Address Line | 431 THOMPSON AVE SUITE B
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City | EL DORADO
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State | AR
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Zip | 71730-4553
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Country | US
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Telephone | 870-639-8128
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Fax | 870-639-8129
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Authorized Official
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Title or Position | OWNER
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Name | VERONICA SEGRETO
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Credential |
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Telephone | 870-639-8128
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0404X
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Taxonomy Name | Cardiac Rehabilitation Clinic/Center
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License Number |
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License Number State |
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