Provider Demographics
NPI:1205452067
Name:VIRA WELLNESS, LLC
Entity type:Organization
Organization Name:VIRA WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:PROENZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-669-1125
Mailing Address - Street 1:2429 HOLLYWOOD BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-6605
Mailing Address - Country:US
Mailing Address - Phone:954-669-1125
Mailing Address - Fax:954-688-7010
Practice Address - Street 1:2429 HOLLYWOOD BLVD STE 300
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-6605
Practice Address - Country:US
Practice Address - Phone:954-669-1125
Practice Address - Fax:954-688-7010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-17
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy