Provider Demographics
NPI:1144603457
Name:BEYOND WELLNESS SOLUTIONS, LLC
Entity Type:Organization
Organization Name:BEYOND WELLNESS SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NIDIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:DOM, AP
Authorized Official - Phone:727-914-7737
Mailing Address - Street 1:449 CENTRAL AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701
Mailing Address - Country:US
Mailing Address - Phone:727-914-7737
Mailing Address - Fax:
Practice Address - Street 1:449 CENTRAL AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-3863
Practice Address - Country:US
Practice Address - Phone:727-914-7737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-06
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2527171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty