Organization
NCC WELLNESS SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
YAIMA HURTADO SOTO (VICE PRESIDENT)
(786) 263-8726
Entity
Organization
Contact information
Practice address
1886 SW 57TH AVE, MIAMI, FL 33155-2139
(786) 263-8726
Mailing address
1886 SW 57TH AVE, MIAMI, FL 33155-2139
(305) 791-9661
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
207Q00000X
Family Medicine Physician
—
—
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
126431200
—
FL
01
—
V5406
MEDICARE
FL
Enumeration date
04/12/2025
Last updated
04/30/2026
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