Basic Information
| Provider Information | |||||||||
| NPI: | 1396987004 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WELLMAX MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7928 SW 8TH ST | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331444209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052614441 | ||||||||
| FaxNumber: | 3052623564 | ||||||||
| Practice Location | |||||||||
| Address1: | 7928 SW 8TH ST | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331444209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052614441 | ||||||||
| FaxNumber: | 3052623564 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2009 | ||||||||
| LastUpdateDate: | 01/13/2011 | ||||||||
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| AuthorizedOfficialLastName: | DIAZ | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3052614441 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QH0100X | HCC4476 | FL | Y | Ambulatory Health Care Facilities | Clinic/Center | Health Service |
No ID Information.