Provider Demographics
NPI:1346128907
Name:ELITE WELLNESS CLUB
Entity type:Organization
Organization Name:ELITE WELLNESS CLUB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EDIRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:OJEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-998-1018
Mailing Address - Street 1:28 W FLAGLER ST STE 550
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33130-1891
Mailing Address - Country:US
Mailing Address - Phone:786-907-4904
Mailing Address - Fax:
Practice Address - Street 1:28 W FLAGLER ST STE 550
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33130-1891
Practice Address - Country:US
Practice Address - Phone:786-907-4904
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-22
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty