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Organization
INITIUM NOVUM LLC
Active
Organization
INITIUM NOVUM LLC
Active
Other names
Venom Performance Training
Organization subpart
No
Provider details
NPI number
Authorized official
TERRENCE VALENTINO BAILEY EXERCISEPHYSIOLOGIST (DIRECTOR OF HUMAN PERFORMANCE)
(310) 367-7517
Entity
Organization
Contact information
Practice address
1657 N MIAMI AVE APT 515, MIAMI, FL 33136-2010
(310) 367-7517
Mailing address
1657 N MIAMI AVE APT 515, MIAMI, FL 33136-2010
(310) 367-7517
Taxonomy
Speciality
Code
Description
License number
State
2083P0901X
Public Health & General Preventive Medicine Physician
Primary
—
NULL
2083P0901X
Public Health & General Preventive Medicine Physician
Primary
—
—
251K00000X
Public Health or Welfare Agency
—
NULL
261QC1500X
Community Health Clinic/Center
—
NULL
261QC1800X
Corporate Health Clinic/Center
—
NULL
261QP2000X
Physical Therapy Clinic/Center
—
NULL
Other
Enumeration date
06/12/2019
Last updated
06/12/2019
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