Provider Demographics
NPI:1851686943
Name:THE WELLNESS CENTER OF LONDON SQUARE INC.
Entity Type:Organization
Organization Name:THE WELLNESS CENTER OF LONDON SQUARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR / CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-385-3939
Mailing Address - Street 1:13550 SW 120TH ST STE 518
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-7507
Mailing Address - Country:US
Mailing Address - Phone:305-385-3939
Mailing Address - Fax:305-385-3466
Practice Address - Street 1:13550 SW 120TH ST STE 518
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-7507
Practice Address - Country:US
Practice Address - Phone:305-385-3939
Practice Address - Fax:305-385-3466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-16
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty