Healthcare Provider Details

I. General information

NPI: 1902668536
Provider Name (Legal Business Name): BWELL MED CENTER CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2024
Last Update Date: 01/29/2024
Certification Date: 01/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10500 NW 26TH ST STE A102A
DORAL FL
33172-2158
US

IV. Provider business mailing address

10500 NW 26TH ST STE A102A
DORAL FL
33172-2158
US

V. Phone/Fax

Practice location:
  • Phone: --
  • Fax:
Mailing address:
  • Phone: 305-364-5182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CESAR PEREZ
Title or Position: OWNER
Credential: MD
Phone: --