Provider Demographics
NPI:1417053331
Name:WONDER INTERNATIONAL INC
Entity Type:Organization
Organization Name:WONDER INTERNATIONAL INC
Other - Org Name:PRIMARY CARE HOLISTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DI
Authorized Official - Middle Name:
Authorized Official - Last Name:FU
Authorized Official - Suffix:
Authorized Official - Credentials:AP
Authorized Official - Phone:954-752-8888
Mailing Address - Street 1:2165 SW 130TH TER
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-2660
Mailing Address - Country:US
Mailing Address - Phone:954-752-8888
Mailing Address - Fax:954-441-8532
Practice Address - Street 1:8050 N UNIVERSITY DR STE 103
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2102
Practice Address - Country:US
Practice Address - Phone:954-752-8888
Practice Address - Fax:954-721-8843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP595171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC0254Medicare UPIN