Healthcare Provider Details

I. General information

NPI: 1891074084
Provider Name (Legal Business Name): WELLMED MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2011
Last Update Date: 08/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9621 BIRD RD
MIAMI FL
33165-4030
US

IV. Provider business mailing address

9621 BIRD RD
MIAMI FL
33165-4030
US

V. Phone/Fax

Practice location:
  • Phone: 305-418-0841
  • Fax: 305-418-0849
Mailing address:
  • Phone: 305-418-0841
  • Fax: 305-418-0849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State

VIII. Authorized Official

Name: EULISES ESCALONA SR.
Title or Position: PRESIDENT
Credential: R.N.
Phone: 305-418-0841