Provider Demographics
NPI:1083970958
Name:1ST WELL CARE HEALTH INC
Entity Type:Organization
Organization Name:1ST WELL CARE HEALTH INC
Other - Org Name:1ST WELL CARE HEALTH INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SORAYA
Authorized Official - Middle Name:CHAVEZ
Authorized Official - Last Name:QUINJANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-779-0110
Mailing Address - Street 1:14750 SW 26TH ST
Mailing Address - Street 2:SUITE#202
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-5933
Mailing Address - Country:US
Mailing Address - Phone:561-779-0110
Mailing Address - Fax:
Practice Address - Street 1:14750 SW 26 ST
Practice Address - Street 2:SUITE 202
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185
Practice Address - Country:US
Practice Address - Phone:561-779-0110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-05
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty