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Organization
SOUTHEAST WELLNESS LANE CORP
Active
Organization
SOUTHEAST WELLNESS LANE CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. YURI SALAS ESPINOSA MD (PRESIDENT)
(786) 493-2293
Entity
Organization
Contact information
Practice address
13265 SW 39TH ST, DAVIE, FL 33330-4748
(786) 493-2293
Mailing address
13265 SW 39TH ST, DAVIE, FL 33330-4748
(786) 493-2293
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006456700
—
FL
Enumeration date
03/21/2019
Last updated
03/21/2019
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