Organization Name: | RIVERSIDE WELLNESS CENTER INC |
NPI Number: | 1457698664 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MICHAEL TORRES (OWNER) |
Mailing Address: | 7911 Nw 72nd Ave Suite 114 Medley |
State: | FL US |
Postal Code: | 331662227 |
Phone Number: | 7864528351 |
Fax Number: | 7865183364 |
NPI Enumeration Date: | 01/08/2013 |
NPI Last Update Date: | 01/08/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | HCC 9594 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |