Healthcare Provider Details

I. General information

NPI: 1316616063
Provider Name (Legal Business Name): WELLMAX HEALTH MEDICAL CENTERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2021
Last Update Date: 09/07/2021
Certification Date: 08/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4925 SHERIDAN ST
HOLLYWOOD FL
33021-2834
US

IV. Provider business mailing address

9250 W FLAGLER ST STE 600
MIAMI FL
33174-3460
US

V. Phone/Fax

Practice location:
  • Phone: 786-422-6821
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: VANESSA VILLALI
Title or Position: DIR PRACTICE MGMT LDR
Credential:
Phone: 305-586-7288