1285361220 NPI number — INFINITY WELLNESS SOLUTIONS LLC

Table of content: (NPI 1285361220)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285361220 NPI number — INFINITY WELLNESS SOLUTIONS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INFINITY WELLNESS SOLUTIONS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285361220
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
151 CALLE DE SAN FRANCISCO
Provider Second Line Business Mailing Address:
STE 200 PMB 0919
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00901-1607
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
470-202-8958
Provider Business Mailing Address Fax Number:
888-201-5943

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
151 CALLE DE SAN FRANCISCO
Provider Second Line Business Practice Location Address:
STE 200 PMB 0919
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00901-1607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
470-202-8958
Provider Business Practice Location Address Fax Number:
888-201-5943
Provider Enumeration Date:
08/01/2022

Additional Information

Authorized Official

Authorized Official Last Name:
CAINE
Authorized Official First Name:
CRYSTAL
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
470-202-8958

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com