Healthcare Provider Details

I. General information

NPI: 1326713041
Provider Name (Legal Business Name): PERFECT WELLNESS CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2021
Last Update Date: 03/25/2022
Certification Date: 03/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19100 SW 106TH AVE UNIT 12
CUTLER BAY FL
33157-7643
US

IV. Provider business mailing address

19100 SW 106TH AVE UNIT 12
CUTLER BAY FL
33157-7643
US

V. Phone/Fax

Practice location:
  • Phone: 305-395-0281
  • Fax:
Mailing address:
  • Phone: 305-395-0281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALBERTO MARTINEZ MEDINA
Title or Position: PRESIDENT
Credential:
Phone: 305-395-0281