Healthcare Provider Details

I. General information

NPI: 1366231995
Provider Name (Legal Business Name): IM WELLNESS CENTER,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2025
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22339 SW 112TH AVE UNIT C
MIAMI FL
33170-6543
US

IV. Provider business mailing address

22339 SW 112TH AVE UNIT C
MIAMI FL
33170-6543
US

V. Phone/Fax

Practice location:
  • Phone: 786-701-9908
  • Fax: 305-574-9844
Mailing address:
  • Phone: 786-701-9908
  • Fax: 305-574-9844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: IRAISY MENDEZ
Title or Position: PMHNP/OWNER
Credential: PMHNP
Phone: 786-332-9540