Provider Demographics
NPI:1710452446
Name:ENERGY YOGA & WELLNESS LLC
Entity Type:Organization
Organization Name:ENERGY YOGA & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:YGLESIAS
Authorized Official - Suffix:
Authorized Official - Credentials:RYT500E
Authorized Official - Phone:305-562-7051
Mailing Address - Street 1:5440 NW 104TH CT
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-2684
Mailing Address - Country:US
Mailing Address - Phone:305-562-7051
Mailing Address - Fax:
Practice Address - Street 1:11402 NW 41ST ST STE 225
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-4859
Practice Address - Country:US
Practice Address - Phone:305-486-3270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-09
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty