Healthcare Provider Details

I. General information

NPI: 1881421824
Provider Name (Legal Business Name): MED-WELL HEALTHCARE SPECIALISTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2024
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 SW 137TH AVE STE 206
MIAMI FL
33175-6312
US

IV. Provider business mailing address

2450 SW 137TH AVE STE 206
MIAMI FL
33175-6312
US

V. Phone/Fax

Practice location:
  • Phone: 305-381-5420
  • Fax: 305-381-5335
Mailing address:
  • Phone: 305-381-5420
  • Fax: 305-381-5335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ISRAEL LIBERA
Title or Position: CFO
Credential:
Phone: 786-606-9181