MEDICARE: ALLASSO WELLNESS COUNSELING, 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	305R00000X	Preferred Provider Organization
2	302R00000X	Health Maintenance Organization

General Provider Information

NPI Number	:	1932400900
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLASSO WELLNESS COUNSELING, LLC.

Provider Business Mailing Address
First Line	:	1735 W 65TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-6111
Country	:	US
Telephone Number	:	305-335-0707
Fax Number	:

Provider Business Practice Location Address
First Line	:	1735 W 65TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-6111
Country	:	US
Telephone Number	:	305-335-0707
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JOSE LEOBARDO DIAZ
Credential	:
Telephone Number	:	305-335-0707

Provider Enumeration Date	:	11/08/2010
Last Update Date	:	08/25/2011

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