Healthcare Provider Details

I. General information

NPI: 1750046579
Provider Name (Legal Business Name): ZOOM WELLNESS MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2021
Last Update Date: 11/05/2021
Certification Date: 11/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

844 BROKEN SOUND PKWY NW APT 304
BOCA RATON FL
33487-3664
US

IV. Provider business mailing address

844 BROKEN SOUND PKWY NW APT 304
BOCA RATON FL
33487-3664
US

V. Phone/Fax

Practice location:
  • Phone: 954-612-7709
  • Fax:
Mailing address:
  • Phone: 954-612-7709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name: MR. MARCOS VALENTINO MARTINEZ
Title or Position: OWNER/CEO
Credential:
Phone: 954-612-7709