Provider Demographics
NPI:1205127578
Name:FLORIDA WELLNESS & REHAB CTR BILLING LLC
Entity type:Organization
Organization Name:FLORIDA WELLNESS & REHAB CTR BILLING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:CERECEDA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:305-888-5280
Mailing Address - Street 1:51 EAST 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010
Mailing Address - Country:US
Mailing Address - Phone:305-888-5280
Mailing Address - Fax:305-888-5299
Practice Address - Street 1:51 EAST 1ST AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010
Practice Address - Country:US
Practice Address - Phone:305-888-5280
Practice Address - Fax:305-888-5299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-21
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6867302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization