Provider Demographics
NPI:1235495532
Name:TOTAL BODY WELLNESS CENTER OF MIAMI LAKES
Entity Type:Organization
Organization Name:TOTAL BODY WELLNESS CENTER OF MIAMI LAKES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NILAJA
Authorized Official - Middle Name:
Authorized Official - Last Name:BIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-533-7614
Mailing Address - Street 1:18520 NW 67TH AVE
Mailing Address - Street 2:STE 278
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-3302
Mailing Address - Country:US
Mailing Address - Phone:786-235-9096
Mailing Address - Fax:
Practice Address - Street 1:18400 NW 75TH PL
Practice Address - Street 2:STE 119
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-2955
Practice Address - Country:US
Practice Address - Phone:786-235-9096
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-11
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7686207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty