Provider Demographics
NPI:1124669528
Name:THE HEALERS SPACE WELLNESS CENTER PSC
Entity type:Organization
Organization Name:THE HEALERS SPACE WELLNESS CENTER PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:I
Authorized Official - Last Name:ROSA ROMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:939-219-1148
Mailing Address - Street 1:3106 AVE JUAN HERNANDEZ ORTIZ
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-3614
Mailing Address - Country:US
Mailing Address - Phone:787-872-5042
Mailing Address - Fax:
Practice Address - Street 1:3106 AVE JUAN HERNANDEZ ORTIZ
Practice Address - Street 2:
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-3614
Practice Address - Country:US
Practice Address - Phone:787-872-5042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-07
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty