| Living Well Management, Inc | |
|
3601 W Commercial Blvd Ste 21 Fort Lauderdale FL 33309-3320 | |
| (954) 909-0407 | |
| (954) 909-0408 |
| Full Name | Living Well Management, Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 3601 W Commercial Blvd Ste 21, Fort Lauderdale, Florida |
| Authorized Official Name and Position | Joel Alejo Quintero (CEO) |
| Authorized Official Contact | 3053428736 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Living Well Management, Inc 8725 Nw 18th Ter Ste 102 Doral FL 33172-2629 Ph: (305) 342-8736 | Living Well Management, Inc 3601 W Commercial Blvd Ste 21 Fort Lauderdale FL 33309-3320 Ph: (954) 909-0407 |
| NPI Number | 1134782154 |
|---|---|
| Provider Enumeration Date | 04/16/2019 |
| Last Update Date | 10/06/2021 |
| Medicare PECOS PAC ID | 6204225261 |
|---|---|
| Medicare Enrollment ID | O20211112000104 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134782154 | NPI | - | NPPES |
| 34545 | Other | FL | AHCA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| 324500000X | Substance Abuse Rehabilitation Facility | (* (Not Available)) | Secondary |
| Provider Name | Fernando L Soutullo |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1346257805 PECOS PAC ID: 5395728885 Enrollment ID: I20040607001448 |
| Provider Name | Raul A Tamayo |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1356373112 PECOS PAC ID: 2264418441 Enrollment ID: I20040629000284 |
| Provider Name | Mayloren Mendez |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1972911402 PECOS PAC ID: 8426366196 Enrollment ID: I20150929002203 |
| Provider Name | Natacha Coca |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104331313 PECOS PAC ID: 7214274489 Enrollment ID: I20190125000834 |
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