Healthcare Provider Details

I. General information

NPI: 1033025846
Provider Name (Legal Business Name): PRO WELL MEDICAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

273 AUTUMN RIDGE RD
DELTONA FL
32725-9424
US

IV. Provider business mailing address

273 AUTUMN RIDGE RD
DELTONA FL
32725-9424
US

V. Phone/Fax

Practice location:
  • Phone: 407-463-8792
  • Fax:
Mailing address:
  • Phone: 407-463-8792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. ALEJANDRO FONSECA POEY
Title or Position: CEO
Credential: MD
Phone: 407-463-8792