Healthcare Provider Details

I. General information

NPI: 1104647288
Provider Name (Legal Business Name): CENTER FOR WOMENS WELLNESS CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2024
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8501 SW 124TH AVE STE 211
MIAMI FL
33183-4633
US

IV. Provider business mailing address

20940 SW 132ND AVE
MIAMI FL
33177-6228
US

V. Phone/Fax

Practice location:
  • Phone: 305-595-6488
  • Fax: 305-595-3532
Mailing address:
  • Phone: 786-414-6133
  • Fax: 305-595-3532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: YESIKA VILLAFANA
Title or Position: OWNER/CEO
Credential:
Phone: 786-432-9111