Provider Demographics
NPI:1114199775
Name:C WELLNESS,INC
Entity Type:Organization
Organization Name:C WELLNESS,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARDENTEY
Authorized Official - Suffix:
Authorized Official - Credentials:AP
Authorized Official - Phone:786-859-6216
Mailing Address - Street 1:8520 SW 97TH RD
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-4069
Mailing Address - Country:US
Mailing Address - Phone:786-859-6216
Mailing Address - Fax:305-222-6199
Practice Address - Street 1:6303 SW 40TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-4825
Practice Address - Country:US
Practice Address - Phone:305-667-4389
Practice Address - Fax:305-222-6199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP1711171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAP1711OtherLIC#
FLAP1711OtherLIC#