Provider Demographics
NPI:1053184259
Name:O&M FAMILY WELLNESS CENTER, LLC
Entity type:Organization
Organization Name:O&M FAMILY WELLNESS CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:OSLEIDY
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:239-465-2365
Mailing Address - Street 1:3224 I 30 STE 137
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-2675
Mailing Address - Country:US
Mailing Address - Phone:239-465-2365
Mailing Address - Fax:
Practice Address - Street 1:3224 I 30 STE 137
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-2675
Practice Address - Country:US
Practice Address - Phone:239-465-2365
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-31
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty