Southeast Wellness Lane Corp

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

SOUTHEAST WELLNESS LANE CORP

Practice address

13265 SW 39TH St
Davie, FL 33330-4748

Phone

(786) 493-2293

NPI assigned

Mar 21, 2019

Organization subpart

No

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

Authorized official

Name

Dr. Yuri Salas Espinosa, MD

Title

President

Phone

(786) 493-2293

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1553126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1553126400000",
    "number": "1962962316",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13265 SW 39TH ST",
            "city": "DAVIE",
            "state": "FL",
            "postal_code": "333304748",
            "telephone_number": "786-493-2293"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13265 SW 39TH ST",
            "city": "DAVIE",
            "state": "FL",
            "postal_code": "333304748",
            "telephone_number": "786-493-2293"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST WELLNESS LANE CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-21",
        "last_updated": "2019-03-21",
        "status": "A",
        "authorized_official_last_name": "SALAS ESPINOSA",
        "authorized_official_first_name": "YURI",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "786-493-2293",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "006456700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Davie, FL
• Providers in Davie, FL by specialty
• Internal Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2019; 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.