Provider Demographics
NPI:1700597507
Name:MD HEALTH AND WELLNESS
Entity Type:Organization
Organization Name:MD HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MAURICIO
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-655-6079
Mailing Address - Street 1:7415 NW 33RD ST UNIT 4201
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-2393
Mailing Address - Country:US
Mailing Address - Phone:954-655-6079
Mailing Address - Fax:
Practice Address - Street 1:1806 N FLAMINGO RD STE 220
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-1030
Practice Address - Country:US
Practice Address - Phone:954-655-6079
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMEDICO2005OtherPRIVATE INSURANCE