Provider Demographics
NPI:1003427832
Name:T.A HEALTH AND WELLNESS LLC
Entity Type:Organization
Organization Name:T.A HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAIMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALFONSO MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:786-856-4499
Mailing Address - Street 1:5500 SW 77TH CT APT 210
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-4379
Mailing Address - Country:US
Mailing Address - Phone:786-856-4499
Mailing Address - Fax:
Practice Address - Street 1:705 E 8TH AVE STE 201
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-4613
Practice Address - Country:US
Practice Address - Phone:305-883-5188
Practice Address - Fax:786-332-3999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-14
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty