Provider Demographics
NPI:1629327465
Name:BOCA WELLNESS, INC.
Entity Type:Organization
Organization Name:BOCA WELLNESS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:NOVEK
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-328-9124
Mailing Address - Street 1:17340 BOCA CLUB BLVD
Mailing Address - Street 2:SUITE 703
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-1024
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17340 BOCA CLUB BLVD
Practice Address - Street 2:SUITE 703
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-1024
Practice Address - Country:US
Practice Address - Phone:954-328-9124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-07
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Single Specialty