Provider Demographics
NPI:1598051971
Name:NIKKEN WELLNESS CENTER INC
Entity Type:Organization
Organization Name:NIKKEN WELLNESS CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HERNANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MA 61484
Authorized Official - Phone:954-239-8528
Mailing Address - Street 1:901 S STATE ROAD 7
Mailing Address - Street 2:430
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33023-6700
Mailing Address - Country:US
Mailing Address - Phone:954-239-8528
Mailing Address - Fax:954-239-8845
Practice Address - Street 1:901 S STATE ROAD 7
Practice Address - Street 2:430
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33023-6700
Practice Address - Country:US
Practice Address - Phone:954-239-8528
Practice Address - Fax:954-239-8845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA61484261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMM27002OtherFLORIDA DPT OF HEALTH