Provider Demographics
NPI:1891502761
Name:OPTUM WELLNESS CENTER LLC
Entity type:Organization
Organization Name:OPTUM WELLNESS CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROSALBA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARVAJAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-309-0088
Mailing Address - Street 1:7245 SW 21ST ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-1406
Mailing Address - Country:US
Mailing Address - Phone:305-309-0088
Mailing Address - Fax:305-309-0099
Practice Address - Street 1:7959 NW 2ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-8000
Practice Address - Country:US
Practice Address - Phone:305-309-0088
Practice Address - Fax:305-309-0099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-14
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)