MEDICARE: WORLDWIDE DIABETIC HEALTH & NUTRITION 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
1	3336M0002X	Mail Order Pharmacy

General Provider Information

NPI Number	:	1235788472
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WORLDWIDE DIABETIC HEALTH & NUTRITION CENTER LLC

Provider Business Mailing Address
First Line	:	11 S DIXIE HWY
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33460-3727
Country	:	US
Telephone Number	:	954-650-4610
Fax Number	:

Provider Business Practice Location Address
First Line	:	11 S DIXIE HWY
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33460-3727
Country	:	US
Telephone Number	:	954-650-4610
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RALPH AMATO
Credential	:
Telephone Number	:	954-650-4610

Provider Enumeration Date	:	09/10/2019
Last Update Date	:	09/10/2019

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