Provider Demographics
NPI:1992009492
Name:ELITE HEALTH AND WELLNESS CLINIC
Entity Type:Organization
Organization Name:ELITE HEALTH AND WELLNESS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:CATINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOTT
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:786-376-0999
Mailing Address - Street 1:142 NE 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-4204
Mailing Address - Country:US
Mailing Address - Phone:786-376-0999
Mailing Address - Fax:305-674-1217
Practice Address - Street 1:142 NE 1ST AVE
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-4204
Practice Address - Country:US
Practice Address - Phone:786-376-0999
Practice Address - Fax:305-674-1217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-27
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain