Provider Demographics
NPI:1932504370
Name:COMMUNITY HEALTH AND WELLNESS CENTER OF MIAMI INC
Entity Type:Organization
Organization Name:COMMUNITY HEALTH AND WELLNESS CENTER OF MIAMI INC
Other - Org Name:COMMUNITY HEALTH AND WELLNESS CENTER OF MIAMI INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MASIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MOREIRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-541-5245
Mailing Address - Street 1:759 NW 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-3365
Mailing Address - Country:US
Mailing Address - Phone:305-541-5245
Mailing Address - Fax:305-541-5246
Practice Address - Street 1:759 NW 22ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-3365
Practice Address - Country:US
Practice Address - Phone:305-541-5245
Practice Address - Fax:305-541-5246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-28
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90682207Q00000X
FLME153322084P0800X
FLACN613208D00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty