Provider Demographics
NPI:1902294234
Name:HOLLISTIC MEDICAL CENTER INC
Entity Type:Organization
Organization Name:HOLLISTIC MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANABELL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBAYNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-860-1766
Mailing Address - Street 1:330 SW 27TH AVE
Mailing Address - Street 2:SUITE 706
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-2961
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:330 SW 27TH AVE
Practice Address - Street 2:SUITE 706
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-2961
Practice Address - Country:US
Practice Address - Phone:917-860-1766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-09
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 14277174400000X
174400000X
FLME14277174400000X
FLMA43453174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty