Provider Demographics
NPI:1407415946
Name:WELLNESS ESSENTIALS LLC
Entity Type:Organization
Organization Name:WELLNESS ESSENTIALS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CESAR
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:LUNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-960-0438
Mailing Address - Street 1:2290 S VOLUSIA AVE STE C
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-7600
Mailing Address - Country:US
Mailing Address - Phone:386-960-0438
Mailing Address - Fax:386-960-0450
Practice Address - Street 1:2290 S VOLUSIA AVE STE C
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-7600
Practice Address - Country:US
Practice Address - Phone:386-960-0438
Practice Address - Fax:386-960-0450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-09
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty