Provider Demographics
NPI:1679306849
Name:POSITIVA WELLNESS, LLC
Entity type:Organization
Organization Name:POSITIVA WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIETITIAN, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANNIA
Authorized Official - Middle Name:COLETTE
Authorized Official - Last Name:HENAO
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:954-393-5333
Mailing Address - Street 1:6729 SW 40TH ST
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-3203
Mailing Address - Country:US
Mailing Address - Phone:954-393-5333
Mailing Address - Fax:
Practice Address - Street 1:6729 SW 40TH ST
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-3203
Practice Address - Country:US
Practice Address - Phone:954-393-5333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty