Provider Demographics
NPI:1558681569
Name:FLORIDA WELLNESS & REHABILITATION CENTER OF SOUTH MIAMI, LLC
Entity Type:Organization
Organization Name:FLORIDA WELLNESS & REHABILITATION CENTER OF SOUTH MIAMI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:CERECEDA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:305-669-1808
Mailing Address - Street 1:6075 SUNSET DR FL 4
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-5000
Mailing Address - Country:US
Mailing Address - Phone:305-669-1808
Mailing Address - Fax:305-669-8170
Practice Address - Street 1:6075 SUNSET DR FL 4
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5000
Practice Address - Country:US
Practice Address - Phone:305-669-1808
Practice Address - Fax:305-669-8170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-02
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty