Provider Demographics
NPI:1043778186
Name:SPECTRA HEALTH & WELLNESS LLC
Entity type:Organization
Organization Name:SPECTRA HEALTH & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMPARO
Authorized Official - Middle Name:CABRERA
Authorized Official - Last Name:QUINTANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-583-4033
Mailing Address - Street 1:101 N US HIGHWAY 1 STE 213
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4262
Mailing Address - Country:US
Mailing Address - Phone:877-583-4033
Mailing Address - Fax:561-935-9889
Practice Address - Street 1:101 N US HIGHWAY 1 STE 213
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4262
Practice Address - Country:US
Practice Address - Phone:877-583-4033
Practice Address - Fax:561-935-9889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-07
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies