Provider Demographics
NPI:1538711643
Name:DR PROFET HEALTH & WELLNESS CENTER LLC
Entity type:Organization
Organization Name:DR PROFET HEALTH & WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:PROFET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-984-0697
Mailing Address - Street 1:11017 N DALE MABRY HWY STE B
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-3873
Mailing Address - Country:US
Mailing Address - Phone:813-337-7402
Mailing Address - Fax:813-461-6462
Practice Address - Street 1:11017 N DALE MABRY HWY STE B
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-3873
Practice Address - Country:US
Practice Address - Phone:813-337-7402
Practice Address - Fax:813-461-6462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-10
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty