Provider Demographics
NPI:1952801581
Name:MAX HEALTH WELLNESS CORP
Entity Type:Organization
Organization Name:MAX HEALTH WELLNESS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:OSMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERO IZQUIERDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-542-4228
Mailing Address - Street 1:6105 MEMORIAL HWY STE S
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-4506
Mailing Address - Country:US
Mailing Address - Phone:813-542-4228
Mailing Address - Fax:813-542-4229
Practice Address - Street 1:6105 MEMORIAL HWY STE S
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-4506
Practice Address - Country:US
Practice Address - Phone:813-542-4228
Practice Address - Fax:813-542-4229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC11203261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center