Provider Demographics
NPI:1477997013
Name:USA WELLNESS PROVIDERS CORP
Entity Type:Organization
Organization Name:USA WELLNESS PROVIDERS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANGELO
Authorized Official - Middle Name:
Authorized Official - Last Name:CORREA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-683-2223
Mailing Address - Street 1:1050 LEE WAGENER BLVD
Mailing Address - Street 2:230
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33315-3500
Mailing Address - Country:US
Mailing Address - Phone:678-683-2223
Mailing Address - Fax:
Practice Address - Street 1:1050 LEE WAGENER BLVD
Practice Address - Street 2:230
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33315-3500
Practice Address - Country:US
Practice Address - Phone:678-683-2223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-25
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GZ379AOtherMEDICARE PART B