Provider Demographics
NPI:1235820325
Name:KETAMINE WELLNESS CENTER OF FLORIDA
Entity Type:Organization
Organization Name:KETAMINE WELLNESS CENTER OF FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RUDOLF
Authorized Official - Middle Name:
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-367-6261
Mailing Address - Street 1:110 N FEDERAL HWY STE 302
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-4300
Mailing Address - Country:US
Mailing Address - Phone:954-251-2217
Mailing Address - Fax:954-374-8908
Practice Address - Street 1:110 N FEDERAL HWY STE 302
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-4300
Practice Address - Country:US
Practice Address - Phone:818-814-1323
Practice Address - Fax:954-374-8908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty