Provider Demographics
NPI:1316267321
Name:FLORIDA WELLNESS & REHABILITATION CENTER OF LITTLE HAVANA LLC
Entity type:Organization
Organization Name:FLORIDA WELLNESS & REHABILITATION CENTER OF LITTLE HAVANA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:CERECEDA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:305-441-9918
Mailing Address - Street 1:2750 CORAL WAY STE 201
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33145-3200
Mailing Address - Country:US
Mailing Address - Phone:305-441-9918
Mailing Address - Fax:305-441-9945
Practice Address - Street 1:2750 CORAL WAY STE 201
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33145-3200
Practice Address - Country:US
Practice Address - Phone:305-441-9918
Practice Address - Fax:305-441-9945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-02
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty