Provider Demographics
NPI:1609443431
Name:SOUL SAVVY WELLNESS CENTER INC
Entity Type:Organization
Organization Name:SOUL SAVVY WELLNESS CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IDALMA
Authorized Official - Middle Name:
Authorized Official - Last Name:SALDANA TRAVIESO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-738-2225
Mailing Address - Street 1:4800 W FLAGLER ST
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-1446
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4800 W FLAGLER ST
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-1446
Practice Address - Country:US
Practice Address - Phone:786-332-4316
Practice Address - Fax:786-409-3682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-09
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110678400Medicaid