Healthcare Provider Details

I. General information

NPI: 1689559551
Provider Name (Legal Business Name): DWELLNESS LAB CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2025
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4105 E 4TH AVE STE 2D
HIALEAH FL
33013-2318
US

IV. Provider business mailing address

4105 E 4TH AVE STE 2D
HIALEAH FL
33013-2318
US

V. Phone/Fax

Practice location:
  • Phone: 305-419-2679
  • Fax: 786-931-2388
Mailing address:
  • Phone: 305-419-2679
  • Fax: 786-931-2388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: RAUL RODRIGUEZ
Title or Position: CEO
Credential:
Phone: 305-877-2870