Healthcare Provider Details

I. General information

NPI: 1245990019
Provider Name (Legal Business Name): WEDO MEDICAL CENTER CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2021
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 NW 36TH ST
MIAMI FL
33142-5357
US

IV. Provider business mailing address

2215 NW 36TH ST
MIAMI FL
33142-5357
US

V. Phone/Fax

Practice location:
  • Phone: 844-933-6633
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: YUSNIEL MARIN
Title or Position: PRESIDENT
Credential:
Phone: 786-568-3107