Provider Demographics
NPI:1033543715
Name:UNIVERSAL HEALTH AND WELLNESS CENTER
Entity Type:Organization
Organization Name:UNIVERSAL HEALTH AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:SERGIO
Authorized Official - Last Name:MENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-517-1620
Mailing Address - Street 1:9618 PINES BLVD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-6240
Mailing Address - Country:US
Mailing Address - Phone:954-517-1620
Mailing Address - Fax:954-517-1621
Practice Address - Street 1:9618 PINES BLVD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6240
Practice Address - Country:US
Practice Address - Phone:954-517-1620
Practice Address - Fax:954-517-1621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-29
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83615174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFR750AOtherMEDICARE PTAN
FLFR750AOtherMEDICARE PTAN