Healthcare Provider Details

I. General information

NPI: 1720456676
Provider Name (Legal Business Name): MIAMI MEDICAL & WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2015
Last Update Date: 09/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 SW 8TH ST SUITE 103
MIAMI FL
33144-4400
US

IV. Provider business mailing address

1200 ALTON RD
MIAMI BEACH FL
33139-3810
US

V. Phone/Fax

Practice location:
  • Phone: 305-534-0076
  • Fax: 305-735-6471
Mailing address:
  • Phone: 305-534-0076
  • Fax: 305-907-5442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberME58111
License Number StateFL

VIII. Authorized Official

Name: MR. RODOLFO DUMENIGO JR.
Title or Position: PRESIDENT
Credential: M.D
Phone: 305-534-0076