Provider Demographics
NPI:1417633991
Name:HOLY INFANT PRIMARY CARE AND WELLNESS CENTER
Entity Type:Organization
Organization Name:HOLY INFANT PRIMARY CARE AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNA JOSE
Authorized Official - Middle Name:ELISSENDA
Authorized Official - Last Name:CHANOINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-368-7626
Mailing Address - Street 1:6440 NW 170TH TER
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-4600
Mailing Address - Country:US
Mailing Address - Phone:786-368-7626
Mailing Address - Fax:
Practice Address - Street 1:2215 NEBRASKA AVE STE 3-E
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4867
Practice Address - Country:US
Practice Address - Phone:786-368-7626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-27
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty