Basic Information
| Provider Information | |||||||||
| NPI: | 1508096736 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WELLMAX HEALTH MEDICAL CENTERS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9250 W FLAGLER ST STE 600 | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331743460 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3054488100 | ||||||||
| FaxNumber: | 3054449148 | ||||||||
| Practice Location | |||||||||
| Address1: | 6540 NORTHWEST 186 STREET | ||||||||
| Address2: | |||||||||
| City: | MIAMI LAKES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3058202033 | ||||||||
| FaxNumber: | 3058202032 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2009 | ||||||||
| LastUpdateDate: | 03/03/2021 | ||||||||
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| AuthorizedOfficialLastName: | VILLALI | ||||||||
| AuthorizedOfficialFirstName: | VANESSA | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIR PRACTICE MANAGEMENT | ||||||||
| AuthorizedOfficialTelephone: | 3055867288 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | WELLMAX HEALTH DELIVERY NETWORK, LLC | ||||||||
| AuthorizedOfficialNamePrefix: | MISS | ||||||||
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| NPICertificationDate: | 03/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.