| Hathor Wellcare Center Inc | |
|
13335 Sw 124th St Ste 206 Miami FL 33186-7515 | |
| (786) 429-1495 | |
| (786) 227-6780 |
| Full Name | Hathor Wellcare Center Inc |
|---|---|
| Speciality | General Practice |
| Location | 13335 Sw 124th St Ste 206, Miami, Florida |
| Authorized Official Name and Position | Pedro Rafael Fajardo Pompa (OWNER/PRESIDENT) |
| Authorized Official Contact | 7864521751 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Hathor Wellcare Center Inc 13335 Sw 124th St Ste 206 Miami FL 33186-7515 Ph: (786) 429-1495 | Hathor Wellcare Center Inc 13335 Sw 124th St Ste 206 Miami FL 33186-7515 Ph: (786) 429-1495 |
| NPI Number | 1093254716 |
|---|---|
| Provider Enumeration Date | 02/14/2017 |
| Last Update Date | 01/25/2023 |
| Certification Date | 01/25/2023 |
| Medicare PECOS PAC ID | 2860724820 |
|---|---|
| Medicare Enrollment ID | O20191024002762 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093254716 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Secondary |
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Fernando L Soutullo |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1346257805 PECOS PAC ID: 5395728885 Enrollment ID: I20040607001448 |
| Provider Name | Ricardo E Presas |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1770505224 PECOS PAC ID: 4284618208 Enrollment ID: I20040619000023 |
| Provider Name | Carmen D Marti |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598317497 PECOS PAC ID: 7012000235 Enrollment ID: I20200615000933 |
| Provider Name | Ibis Reyes Soto |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548804164 PECOS PAC ID: 3476954603 Enrollment ID: I20210625001222 |
| Provider Name | Anouk Herrera |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1659737559 PECOS PAC ID: 8123417128 Enrollment ID: I20211112001314 |
| Provider Name | Melissa Garcia-martinez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942738950 PECOS PAC ID: 0648665935 Enrollment ID: I20220323002862 |
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