MEDICARE: A&C 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	363LF0000X	Family Nurse Practitioner
2	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1669067344
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A&C WELLNESS LLC

Provider Business Mailing Address
First Line	:	1748 W 56TH TER UNIT 410
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-2006
Country	:	US
Telephone Number	:	786-319-8826
Fax Number	:

Provider Business Practice Location Address
First Line	:	1748 W 56TH TER UNIT 410
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-2006
Country	:	US
Telephone Number	:	786-319-8826
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	CARMEN M PEREZ SANTAMARIA
Credential	:
Telephone Number	:	786-975-3069

Provider Enumeration Date	:	03/04/2021
Last Update Date	:	03/05/2021

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Directions to “A&C WELLNESS LLC ” Practice Location

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