Organization
HEAVEN WELLNESS MEDICAL CENTER, INC.
Active
Organization
HEAVEN WELLNESS MEDICAL CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LAZARA HURTADO HERNANDEZ (OWNER)
(813) 409-9457
Entity
Organization
Contact information
Practice address
11961 N FLORIDA AVE STE B, TAMPA, FL 33612-5213
(813) 415-2891
(813) 443-3149
Mailing address
PO BOX 15542, TAMPA, FL 33684-5542
(813) 415-2891
(813) 443-3149
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
261QH0100X
Health Service Clinic/Center
—
—
261QP2000X
Physical Therapy Clinic/Center
—
—
261QR0400X
Rehabilitation Clinic/Center
—
—
Other
Enumeration date
09/22/2022
Last updated
09/22/2022
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