SOUTHEAST WELLNESS LANE CORP (NPI# 1962962316) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962962316 |
| Entity Type | Organization |
| Organization Name | SOUTHEAST WELLNESS LANE CORP |
| Practice Address |
13265 Sw 39th St Davie FL 33330-4748 |
| Practice Telephone | 7864932293 |
| Mailing Telephone | 7864932293 |
| Enumeration Date | 2019-03-21 |
| Last Update Date | 2019-03-21 |
| Authorized Official Name | DR. YURI SALAS ESPINOSA (PRESIDENT) |
| Authorized Official Telephone | 7864932293 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 006456700 | 05 |
| Street Address |
13265 SW 39TH ST |
| City | DAVIE |
| State | FL |
| Zip Code | 33330-4748 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245830595 | Community Children's Therapy, Inc | Developmental Therapist | 12353 Natalies Cove Rd, Cooper City, FL 33330 | 2020-10-27 |
| 1508365982 | Sun Coast Recovery Ranch LLC | Substance Abuse Rehabilitation Facility | 4801 Hancock Rd, Southwest Ranches, FL 33330 | 2018-02-12 |
| 1487153441 | Everglades Physicians Alliance LLC | Internal Medicine | 4745 Volunteer Road, Suite 301, Davie, FL 33330 | 2018-02-06 |
| 1639689532 | Tariq Azeez | Occupational Therapy Assistant | 4301 S Flamingo Road #101, Davie, FL 33330 | 2017-10-05 |
| 1497129597 | Right Path Recovery, LLC | Substance Abuse Rehabilitation Facility | 4801 Hancock Road, Southwest Ranches, FL 33330 | 2015-11-30 |
| 1104202878 | Meghan Ashley Oswain | Occupational Therapist | 3141 Sw 118 Terrace, Davie, FL 33330 | 2015-08-05 |
| 1588075089 | Nicole Santiago | Respiratory Therapist, Registered | 5117 Sw 122nd Terrace, Cooper City, FL 33330 | 2014-05-19 |
| 1205180171 | Richard L. Sherman, D.d.s. | Dentist | 4725 Sw 148 Ave. Suite 203, Davie, FL 33330 | 2012-10-31 |
| 1952612996 | Vikram V Thakar | Podiatrist | 11302 Sw 55 St, Cooper City, FL 33330 | 2010-06-24 |
| 1376875344 | Carlos E. Spera, Md, Pa | Clinic/Center | 12575 Orange Drive #303, Davie, FL 33330 | 2010-02-02 |
| Find all providers in zip 33330 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538659388 | Primary Care Physicians of Hollywood, Pl | Internal Medicine | 10650 W State Road 84 Ste 104, Davie, FL 33324-4235 | 2018-05-17 |
| 1487153441 | Everglades Physicians Alliance LLC | Internal Medicine | 4745 Volunteer Road, Suite 301, Davie, FL 33330 | 2018-02-06 |
| 1275947434 | Rosa M Ferra | Internal Medicine | 13361 Sw 44th St, Davie, FL 33330-4713 | 2014-06-16 |
| 1255766218 | Medical Care Group LLC | Internal Medicine | 4431 Sw 64th Ave Ste 101, Davie, FL 33314-3458 | 2013-09-10 |
| 1326386848 | Nova Southeastern University | Internal Medicine | 3424 S University Dr, Suite 3440, Davie, FL 33328-2022 | 2013-01-17 |
| 1427351667 | Emile Jean-baptiste | Internal Medicine | 15010 Sw 40th St, Davie, FL 33331-2775 | 2010-12-09 |
| 1013242932 | Dana D Dameron Jr. | Internal Medicine | 4848 Grapevine Way, Davie, FL 33331-3358 | 2009-10-09 |
| 1871779058 | Affordahealth Pain Relief Center Inc | Internal Medicine | 8480 W State Road 84, Davie, FL 33324-4533 | 2008-01-17 |
| 1457543746 | Ivel Cristina De Freitas | Internal Medicine | 4765 Sw 148th Ave Ste 404, Davie, FL 33330-2128 | 2007-08-10 |
| 1972724029 | Azhar Dalal | Internal Medicine | 15358 Sw 37th St, Davie, FL 33331-2743 | 2007-05-02 |
| Find all providers in DAVIE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.