Provider Demographics
NPI:1720548316
Name:HEALTHY STAR WELLNESS CENTER
Entity Type:Organization
Organization Name:HEALTHY STAR WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMINGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-304-6120
Mailing Address - Street 1:2150 CORAL WAY FL 2
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-2629
Mailing Address - Country:US
Mailing Address - Phone:305-304-6120
Mailing Address - Fax:305-640-5821
Practice Address - Street 1:2150 CORAL WAY FL 2
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-2629
Practice Address - Country:US
Practice Address - Phone:305-304-6120
Practice Address - Fax:305-640-5821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-21
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service