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NPI Code Detail

MEDICARE: GENESIS MEDICAL WELLNESS CENTER CORP.

MEDICARE: GENESIS MEDICAL WELLNESS CENTER CORP.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208D00000XGeneral Practice PhysicianAHCA HCC8215FL

General Provider Information

NPI Number : 1548584766
Entity Type Code : Organization
Provider Name (Legal Business Name) : GENESIS MEDICAL WELLNESS CENTER CORP.
Provider Business Mailing Address
First Line : 8356 SW 40TH ST
Second Line : STE L
City : MIAMI
State : FL
Zip : 33155-3356
Country : US
Telephone Number : 305-228-6400
Fax Number : 305-228-6500
Provider Business Practice Location Address
First Line : 8356 SW 40TH ST
Second Line : STE L
City : MIAMI
State : FL
Zip : 33155-3356
Country : US
Telephone Number : 305-228-6400
Fax Number : 305-228-6500
Authorized Official
Title or Position : PRECIDENT
Name : MARIA C VITAL
Credential :
Telephone Number : 305-603-7800
Provider Enumeration Date : 03/17/2010
Last Update Date : 10/15/2012

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Directions to “GENESIS MEDICAL WELLNESS CENTER CORP. ” Practice Location

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