| New Identity Wellness Center Llc | |
|
14601 Sw 29th St Ste 107 Miramar FL 33027-4715 | |
| (786) 804-9405 | |
| Not Available |
| Full Name | New Identity Wellness Center Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 14601 Sw 29th St Ste 107, Miramar, Florida |
| Authorized Official Name and Position | Carilyn/lenon Hernandez/juan (OWNERS) |
| Authorized Official Contact | 7868049405 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| New Identity Wellness Center Llc 14601 Sw 29th St Ste 107 Miramar FL 33027-4715 Ph: (786) 804-9405 | New Identity Wellness Center Llc 14601 Sw 29th St Ste 107 Miramar FL 33027-4715 Ph: (786) 804-9405 |
| NPI Number | 1558984971 |
|---|---|
| Provider Enumeration Date | 05/20/2020 |
| Last Update Date | 09/30/2020 |
| Certification Date | 09/30/2020 |
| Medicare PECOS PAC ID | 5890115422 |
|---|---|
| Medicare Enrollment ID | O20201020000744 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558984971 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Nelson D Hernandez |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1285625079 PECOS PAC ID: 5496743221 Enrollment ID: I20040503000213 |
| Provider Name | Magda Erira |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407223993 PECOS PAC ID: 8325438690 Enrollment ID: I20211130001232 |
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