Healthcare Provider Details

I. General information

NPI: 1407723398
Provider Name (Legal Business Name): M&M HEALTH WELLNESS CLINIC CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2025
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10300 SW 72ND ST STE 200
MIAMI FL
33173-3040
US

IV. Provider business mailing address

10300 SW 72ND ST STE 200
MIAMI FL
33173-3040
US

V. Phone/Fax

Practice location:
  • Phone: 786-816-4417
  • Fax:
Mailing address:
  • Phone: 786-816-4417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MILADYS VIENES
Title or Position: CEO
Credential: APRN
Phone: 786-816-4417