Provider Demographics
NPI:1003427832
Name:T.A HEALTH AND WELLNESS LLC
Entity type:Organization
Organization Name:T.A HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAIMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALFONSO MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:786-856-4499
Mailing Address - Street 1:6831 SW 147TH AVE APT 1B
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-1003
Mailing Address - Country:US
Mailing Address - Phone:786-856-4499
Mailing Address - Fax:
Practice Address - Street 1:5600 SW 135TH AVE STE 202B
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-5101
Practice Address - Country:US
Practice Address - Phone:786-856-4499
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-14
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty