Brevard Wellness Clinc 1 Llc

NPI 1043633795 - Internal Medicine - 207R00000X

NPI Details
NPI 1043633795
Enumeration Date 01/31/2014
Last Updated 01/31/2014
Entity Type Healthcare Provider
Active Over 2 years ago
Authorized Information
Name SRINIVAS RAO SRINIVAS
Position PRESIDENT
Phone (321) 751-9506
Fax (321) 751-9505
Practice Location
1264 MALABAR RD SE
PALM BAY FL, 32907-2556, US
Phone (321) 751-9506
Fax (321) 751-9505
Business Location
1264 MALABAR RD SE
PALM BAY FL, 32907-2556, US
Phone (321) 751-9506
Fax (321) 751-9505
Toxanomy
Taxonomy Code 207R00000X
License State Florida
License Number ME88036
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According to our database, Brevard Wellness Clinc 1 Llc NPI is 1043633795, taxonomy code is 207R00000X and license number is ME88036, license state is located at Florida. Brevard Wellness Clinc 1 Llc physically located at 1264 Malabar Rd Se, Palm Bay FL, 32907-2556. NPI Number 1033115704 has the healthcare provider type.

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1043633795 NPI number is provided on an as is basis without warranty of any kind. 1043633795 is maintained by the National Plan & Provider Enumeration System. The contents of Brevard Wellness Clinc 1 Llc are for informational purposes only.