Provider Demographics
NPI:1508205089
Name:ABRAHAM WELLNESS CENTER
Entity Type:Organization
Organization Name:ABRAHAM WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-523-3042
Mailing Address - Street 1:6801 NW 77TH AVE STE 306C
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33166-2848
Mailing Address - Country:US
Mailing Address - Phone:786-523-3042
Mailing Address - Fax:
Practice Address - Street 1:6801 NW 77TH AVE STE 306C
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33166-2848
Practice Address - Country:US
Practice Address - Phone:786-523-3042
Practice Address - Fax:305-675-3793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-18
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA57988261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service