Provider Demographics
NPI:1831287192
Name:WELLNESS ASSOCIATES OF FLORIDA LLC
Entity Type:Organization
Organization Name:WELLNESS ASSOCIATES OF FLORIDA LLC
Other - Org Name:WELLNESS ASSOCIATES OF FLORIDA INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:AMADO
Authorized Official - Middle Name:ESTEBAN
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-966-3393
Mailing Address - Street 1:5917 S CONGRESS AVE
Mailing Address - Street 2:
Mailing Address - City:ATLANTIS
Mailing Address - State:FL
Mailing Address - Zip Code:33462-1303
Mailing Address - Country:US
Mailing Address - Phone:561-966-3393
Mailing Address - Fax:561-966-9793
Practice Address - Street 1:5917 S CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-1303
Practice Address - Country:US
Practice Address - Phone:561-966-3393
Practice Address - Fax:561-966-9793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC4322261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFL 165OtherMEDSOLUTIOND
FLV2247OtherBCBS
FL2548771OtherAETNA - HMO
FL5843OtherAVMED
FLHCC4322OtherFL STATE LICENSE
FLV2247OtherBCBS