Provider Demographics
NPI:1154641165
Name:FLORIDA WELLNESS & REHABILITATION CENTER OF HIALEAH LLC
Entity Type:Organization
Organization Name:FLORIDA WELLNESS & REHABILITATION CENTER OF HIALEAH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:CERECEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-558-5432
Mailing Address - Street 1:235 W 49TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3713
Mailing Address - Country:US
Mailing Address - Phone:305-558-5432
Mailing Address - Fax:305-824-9446
Practice Address - Street 1:235 W 49TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3713
Practice Address - Country:US
Practice Address - Phone:305-558-5432
Practice Address - Fax:305-824-9446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-02
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty