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: 11/17/2025
Certification Date: 11/17/2025
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 Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
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: OWNER
Credential: PMHNP-BC
Phone: 786-332-9540