Provider Demographics
NPI:1689946824
Name:US MEDICAL CARE WELLINGTON, LLC
Entity Type:Organization
Organization Name:US MEDICAL CARE WELLINGTON, LLC
Other - Org Name:SMART FOR LIFE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SASSON
Authorized Official - Middle Name:
Authorized Official - Last Name:MOULAVI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-445-4489
Mailing Address - Street 1:11903 SOUTHERN BLVD
Mailing Address - Street 2:SUIT 108
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-7644
Mailing Address - Country:US
Mailing Address - Phone:561-792-2000
Mailing Address - Fax:561-792-2090
Practice Address - Street 1:11903 SOUTHERN BLVD
Practice Address - Street 2:SUIT 108
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-7644
Practice Address - Country:US
Practice Address - Phone:561-792-2000
Practice Address - Fax:561-792-2090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-03
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME26716207VB0002X
FLME83741208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VB0002XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObesity MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty