Healthcare Provider Details

I. General information

NPI: 1326650573
Provider Name (Legal Business Name): BWELL CLINICAL RESEARCH CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2020
Last Update Date: 08/20/2020
Certification Date: 08/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 786-953-8043
  • Fax: 305-675-8060
Mailing address:
  • Phone: 786-953-8043
  • Fax: 305-675-8060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1100X
TaxonomyResearch Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAKSE SEBASTIAN MOREJON
Title or Position: PRESIDENT
Credential:
Phone: 786-942-8635