Provider Demographics
NPI:1083296511
Name:HEALTHCARE & WELLNESS ASSOCIATES LLC
Entity Type:Organization
Organization Name:HEALTHCARE & WELLNESS ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-401-4749
Mailing Address - Street 1:5070 PENRYN CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139-7059
Mailing Address - Country:US
Mailing Address - Phone:702-401-4749
Mailing Address - Fax:
Practice Address - Street 1:3430 E FLAMINGO RD STE 200
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-5064
Practice Address - Country:US
Practice Address - Phone:702-478-4507
Practice Address - Fax:702-478-4805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-23
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service