Basic Information
| Provider Information | |||||||||
| NPI: | 1194180885 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | UNIFIED WELLNESS INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 106 PONCE DE LEON ST | ||||||||
| Address2: | |||||||||
| City: | ROYAL PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334111213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9548013888 | ||||||||
| FaxNumber: | 5617919071 | ||||||||
| Practice Location | |||||||||
| Address1: | 106 PONCE DE LEON ST | ||||||||
| Address2: | |||||||||
| City: | ROYAL PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334111213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9548013888 | ||||||||
| FaxNumber: | 5617919071 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2015 | ||||||||
| LastUpdateDate: | 12/22/2015 | ||||||||
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| AuthorizedOfficialLastName: | AGOADO | ||||||||
| AuthorizedOfficialFirstName: | ANDREW | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9548013888 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | A.P. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Acupuncturist |
No ID Information.