MEDICARE: WELLNESS ASSOCIATES OF FLORIDA 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	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center	HCC4322	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	FL 165	OTHER	FL	MEDSOLUTIOND
2	V2247	OTHER	FL	BCBS
3	2548771	OTHER	FL	AETNA - HMO
4	5843	OTHER	FL	AVMED
5	HCC4322	OTHER	FL	FL STATE LICENSE

General Provider Information

NPI Number	:	1831287192
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLNESS ASSOCIATES OF FLORIDA LLC

Provider Business Mailing Address
First Line	:	5917 S CONGRESS AVE
Second Line	:
City	:	ATLANTIS
State	:	FL
Zip	:	33462-1303
Country	:	US
Telephone Number	:	561-966-3393
Fax Number	:	561-966-9793

Provider Business Practice Location Address
First Line	:	5917 S CONGRESS AVE
Second Line	:
City	:	ATLANTIS
State	:	FL
Zip	:	33462-1303
Country	:	US
Telephone Number	:	561-966-3393
Fax Number	:	561-966-9793

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. AMADO ESTEBAN LOPEZ
Credential	:
Telephone Number	:	561-966-3393

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	06/21/2018

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Directions to “WELLNESS ASSOCIATES OF FLORIDA LLC ” Practice Location

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