Provider Demographics
NPI:1265828586
Name:METABOLIC CENTER FOR WELLNESS, P.A.
Entity Type:Organization
Organization Name:METABOLIC CENTER FOR WELLNESS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:DANIELLE
Authorized Official - Last Name:MAZZA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:407-542-0661
Mailing Address - Street 1:30 WINDSORMERE WAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-6512
Mailing Address - Country:US
Mailing Address - Phone:407-542-0661
Mailing Address - Fax:407-542-0668
Practice Address - Street 1:30 WINDSORMERE WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-6512
Practice Address - Country:US
Practice Address - Phone:407-542-0661
Practice Address - Fax:407-542-0668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-13
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9436261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center