Provider Demographics
NPI:1922725332
Name:FAJARDO WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:FAJARDO WELLNESS CENTER LLC
Other - Org Name:EASTER HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSANA
Authorized Official - Middle Name:
Authorized Official - Last Name:LLANES PORTO
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:786-970-9177
Mailing Address - Street 1:7235 CORAL WAY STE 202
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-1451
Mailing Address - Country:US
Mailing Address - Phone:786-432-9108
Mailing Address - Fax:786-432-9109
Practice Address - Street 1:7235 CORAL WAY STE 202
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-1451
Practice Address - Country:US
Practice Address - Phone:786-432-9108
Practice Address - Fax:786-432-9109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-26
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty