Southeast Wellness Lane Corp

NPI #1962962316 in Davie, Florida

Provider Information

NPI Number: 1962962316
Entity Type: Organization
Organization Name: Southeast Wellness Lane Corp
Primary Specialty: Internal Medicine
Enumeration Date: Mar 21, 2019
Last Updated: Mar 21, 2019

Practice Location

Address: 13265 SW 39TH ST
City: Davie
State: Florida
ZIP Code: 33330-4748
Phone: (786) 493-2293

Authorized Official

Name: DR. YURI SALAS ESPINOSA, MD
Title: PRESIDENT
Phone: (786) 493-2293

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Internal Medicine	207R00000X	Primary

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