Provider Demographics
NPI:1952071821
Name:HATHOR WELLCARE CENTER INC
Entity Type:Organization
Organization Name:HATHOR WELLCARE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:RAFAEL
Authorized Official - Last Name:FAJARDO POMPA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-429-1495
Mailing Address - Street 1:13335 SW 124TH ST STE 206
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-7515
Mailing Address - Country:US
Mailing Address - Phone:786-429-1495
Mailing Address - Fax:786-227-6780
Practice Address - Street 1:13335 SW 124TH ST STE 206
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-7515
Practice Address - Country:US
Practice Address - Phone:786-429-1495
Practice Address - Fax:786-227-6780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty