MEDICARE: CONQUEST HEALTH & WELLNESS, 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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1316565252
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONQUEST HEALTH & WELLNESS, LLC.

Provider Business Mailing Address
First Line	:	1317 EDGEWATER DR # 875
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-6350
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2015 SHANNON LAKES CT
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34743-3651
Country	:	US
Telephone Number	:	407-694-6304
Fax Number	:

Authorized Official
Title or Position	:	LCSW/EXECUTIVE DIRECTOR
Name	:	JAVIER ESTEBAN ROSARIO
Credential	:
Telephone Number	:	407-694-6304

Provider Enumeration Date	:	07/07/2020
Last Update Date	:	07/07/2020

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