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NPI Code Detail

MEDICARE: DE LA ROSA WELLNESS CENTER, LLC

MEDICARE: DE LA ROSA WELLNESS CENTER, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261Q00000XClinic/CenterMA35823FL
2261QR0400XRehabilitation Clinic/CenterMA35823FL
3261QP2000XPhysical Therapy Clinic/CenterMA35823FL

General Provider Information

NPI Number : 1013456805
Entity Type Code : Organization
Provider Name (Legal Business Name) : DE LA ROSA WELLNESS CENTER, LLC
Provider Business Mailing Address
First Line : 7392 NW 35TH TER STE 310
Second Line :
City : MIAMI
State : FL
Zip : 33122-1260
Country : US
Telephone Number : 786-360-2046
Fax Number :
Provider Business Practice Location Address
First Line : 7392 NW 35TH TER STE 310
Second Line :
City : MIAMI
State : FL
Zip : 33122-1260
Country : US
Telephone Number : 786-360-2046
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : MR. MARIO DE LA ROSA
Credential :
Telephone Number : 786-360-2046
Provider Enumeration Date : 02/14/2017
Last Update Date : 02/20/2017

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Directions to “DE LA ROSA WELLNESS CENTER, LLC ” Practice Location

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