Provider Demographics
NPI:1104400712
Name:GERARDO MARIA WELLNESS AND CARE CENTER LLC
Entity Type:Organization
Organization Name:GERARDO MARIA WELLNESS AND CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:FUENTES CLARO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-871-9834
Mailing Address - Street 1:1875 W FLAGLER ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-1939
Mailing Address - Country:US
Mailing Address - Phone:386-871-9834
Mailing Address - Fax:
Practice Address - Street 1:1875 W FLAGLER ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-1939
Practice Address - Country:US
Practice Address - Phone:386-871-9834
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health