Provider Demographics
NPI:1265266159
Name:KIRA HEALTH & WELLNESS LLC
Entity type:Organization
Organization Name:KIRA HEALTH & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:
Authorized Official - First Name:YARELIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ PANTOJA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:832-276-3119
Mailing Address - Street 1:16706 CARLTON POND ST
Mailing Address - Street 2:
Mailing Address - City:WIMAUMA
Mailing Address - State:FL
Mailing Address - Zip Code:33598-2436
Mailing Address - Country:US
Mailing Address - Phone:832-276-3119
Mailing Address - Fax:
Practice Address - Street 1:16706 CARLTON POND ST
Practice Address - Street 2:
Practice Address - City:WIMAUMA
Practice Address - State:FL
Practice Address - Zip Code:33598-2436
Practice Address - Country:US
Practice Address - Phone:832-276-3119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-02
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty