Healthcare Provider Details

I. General information

NPI: 1124738539
Provider Name (Legal Business Name): BWELL MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2022
Last Update Date: 11/28/2022
Certification Date: 11/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10500 NW 26TH ST STE A102
DORAL FL
33172-2158
US

IV. Provider business mailing address

10500 NW 26TH ST STE A102
DORAL FL
33172-2158
US

V. Phone/Fax

Practice location:
  • Phone: 305-646-1799
  • Fax:
Mailing address:
  • Phone: 305-646-1799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: EILEEN SHIELDS JIMENEZ
Title or Position: CEO/OWNER
Credential: APRN
Phone: 305-951-4499