Healthcare Provider Details

I. General information

NPI: 1407271844
Provider Name (Legal Business Name): MIAMI MEDICAL & WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2014
Last Update Date: 07/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 E 49TH ST SUITE 1-8
HIALEAH FL
33013-1904
US

IV. Provider business mailing address

1200 ALTON RD
MIAMI BEACH FL
33139-3810
US

V. Phone/Fax

Practice location:
  • Phone: 305-532-3923
  • Fax: 305-532-5868
Mailing address:
  • Phone: 305-534-0076
  • Fax: 305-532-5868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME87037
License Number StateFL

VIII. Authorized Official

Name: MR. RODOLFO DUMENIGO JR.
Title or Position: PRESIDENT
Credential: M.D
Phone: 305-534-0076