Provider Demographics
NPI:1588461412
Name:FENIX WELLNESS, LLC
Entity type:Organization
Organization Name:FENIX WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:ADANYS
Authorized Official - Middle Name:
Authorized Official - Last Name:ALONSO-ALFONSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-998-7885
Mailing Address - Street 1:9855 E FERN ST
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-5413
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9861 E FERN ST
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-5413
Practice Address - Country:US
Practice Address - Phone:786-404-1008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FENIX WELLNESS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-02-27
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty