Provider Demographics
NPI:1073105227
Name:LABISTE MEDICAL AND WELLNESS CENTER, INC
Entity Type:Organization
Organization Name:LABISTE MEDICAL AND WELLNESS CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAYDA
Authorized Official - Middle Name:C
Authorized Official - Last Name:LABISTE
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:954-470-4609
Mailing Address - Street 1:1780 SW 127TH TER
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-2537
Mailing Address - Country:US
Mailing Address - Phone:305-322-6357
Mailing Address - Fax:
Practice Address - Street 1:7100 W 20TH AVE STE 315
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1811
Practice Address - Country:US
Practice Address - Phone:954-470-4609
Practice Address - Fax:954-516-0612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-09
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty