Date Wellness Center Inc

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

License

OS12303 Issued in FL

Legal business name

DATE WELLNESS CENTER INC

Practice address

5190 NW 167TH St
Ste 308
Miami Lakes, FL 33014-6328

Phone

(305) 974-5683

Fax

(305) 646-1361

NPI assigned

Sep 24, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jessica Kelner, MD

Title

Medical Director

Phone

(305) 974-5683

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1411516800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1411516800000",
    "number": "1154723823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5190 NW 167TH ST",
            "address_2": "STE 308",
            "city": "MIAMI LAKES",
            "state": "FL",
            "postal_code": "330146328",
            "telephone_number": "305-974-5683",
            "fax_number": "305-646-1361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5190 NW 167TH ST",
            "address_2": "STE 308",
            "city": "MIAMI LAKES",
            "state": "FL",
            "postal_code": "330146328",
            "telephone_number": "305-974-5683",
            "fax_number": "305-646-1361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DATE WELLNESS CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-24",
        "last_updated": "2014-09-24",
        "status": "A",
        "authorized_official_last_name": "KELNER",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "305-974-5683",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "FL",
            "license": "OS12303",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Health Service Clinic/Center in Miami Lakes, FL
• Providers in Miami Lakes, FL by specialty
• Health Service Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.