Provider Demographics
NPI:1770060493
Name:OASIS WELLNESS CENTER OF FLORIDA, LLC
Entity type:Organization
Organization Name:OASIS WELLNESS CENTER OF FLORIDA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:YELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:INGUANZO
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:305-613-5125
Mailing Address - Street 1:4410 W 16TH AVE STE 59
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-7194
Mailing Address - Country:US
Mailing Address - Phone:305-824-8559
Mailing Address - Fax:305-824-8561
Practice Address - Street 1:4410 W 16TH AVE STE 59
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-7194
Practice Address - Country:US
Practice Address - Phone:305-824-8559
Practice Address - Fax:305-824-8561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-25
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health