Provider Demographics
NPI:1003530148
Name:MI SALUD WELLNESS CENTER
Entity Type:Organization
Organization Name:MI SALUD WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:CANETE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-220-4421
Mailing Address - Street 1:200 E. WYOMING AVE.
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19120-4411
Mailing Address - Country:US
Mailing Address - Phone:215-220-4421
Mailing Address - Fax:
Practice Address - Street 1:200 E. WYOMING AVE.
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19120-4411
Practice Address - Country:US
Practice Address - Phone:215-220-4421
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No251S00000XAgenciesCommunity/Behavioral Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service