Provider Demographics
NPI:1114515186
Name:ADVANCED WELLNESS CONSULTANTS LLC
Entity Type:Organization
Organization Name:ADVANCED WELLNESS CONSULTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:E
Authorized Official - Last Name:ROSAS SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:786-447-1570
Mailing Address - Street 1:2822 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33322-2450
Mailing Address - Country:US
Mailing Address - Phone:754-223-2321
Mailing Address - Fax:954-252-4026
Practice Address - Street 1:5291 SW 14TH ST
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-5450
Practice Address - Country:US
Practice Address - Phone:786-447-1570
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-06
Last Update Date:2022-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty