Provider Demographics
NPI:1407562267
Name:360 WELLNESS LLC
Entity Type:Organization
Organization Name:360 WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SYLMA
Authorized Official - Middle Name:GRISELLE
Authorized Official - Last Name:ALCAIDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-529-8400
Mailing Address - Street 1:522 CALLE CESAR GONZALEZ
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-2651
Mailing Address - Country:US
Mailing Address - Phone:787-529-8400
Mailing Address - Fax:
Practice Address - Street 1:522 CALLE CESAR GONZALEZ
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-2651
Practice Address - Country:US
Practice Address - Phone:787-529-8400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service