Provider Demographics
NPI:1982572053
Name:LAKES HEALTHCARE & WELLNESS
Entity type:Organization
Organization Name:LAKES HEALTHCARE & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUZA
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:786-261-9628
Mailing Address - Street 1:8205 COMMERCE WAY STE 125
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1668
Mailing Address - Country:US
Mailing Address - Phone:786-261-9628
Mailing Address - Fax:305-827-5545
Practice Address - Street 1:8205 COMMERCE WAY STE 125
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-1668
Practice Address - Country:US
Practice Address - Phone:786-261-9628
Practice Address - Fax:305-827-5545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-29
Last Update Date:2025-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, AmbulatoryGroup - Multi-Specialty
No2083T0002XAllopathic & Osteopathic PhysiciansPreventive MedicineMedical ToxicologyGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty