| Blue Pearl Wellness | |
|
4101 Ravenswood Rd Ste 202 Fort Lauderdale FL 33312-5301 | |
| (954) 251-3454 | |
| (954) 251-3474 |
| Full Name | Blue Pearl Wellness |
|---|---|
| Speciality | Clinic/Center |
| Location | 4101 Ravenswood Rd Ste 202, Fort Lauderdale, Florida |
| Authorized Official Name and Position | Ariadna Gonzalez (OFFICER) |
| Authorized Official Contact | 9542513454 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Blue Pearl Wellness 4101 Ravenswood Rd Ste 202 Fort Lauderdale FL 33312-5301 Ph: (954) 251-3454 | Blue Pearl Wellness 4101 Ravenswood Rd Ste 202 Fort Lauderdale FL 33312-5301 Ph: (954) 251-3454 |
| NPI Number | 1407596810 |
|---|---|
| Provider Enumeration Date | 04/01/2022 |
| Last Update Date | 05/03/2024 |
| Medicare PECOS PAC ID | 1153791405 |
|---|---|
| Medicare Enrollment ID | O20221230001120 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407596810 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| 261QR1100X | Clinic/center - Research | (* (Not Available)) | Primary |
| Provider Name | Santiago A Cardenas |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1245238203 PECOS PAC ID: 6305861014 Enrollment ID: I20051012000216 |
| Provider Name | Rafael E Segura Herrera |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982251070 PECOS PAC ID: 5890171680 Enrollment ID: I20221001000005 |
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