Provider Demographics
NPI:1922470137
Name:72 WELLNESS CENTER
Entity Type:Organization
Organization Name:72 WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT , ACUPUNCTURIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ABEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FIGUEREDO
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:786-715-4609
Mailing Address - Street 1:2925 AVENTURA BLVD STE 306
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-3109
Mailing Address - Country:US
Mailing Address - Phone:786-715-4609
Mailing Address - Fax:
Practice Address - Street 1:2925 AVENTURA BLVD STE 306
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-3109
Practice Address - Country:US
Practice Address - Phone:786-715-4609
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-27
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 2739171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty