Healthcare Provider Details

I. General information

NPI: 1134855976
Provider Name (Legal Business Name): WAVE MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2022
Last Update Date: 03/01/2024
Certification Date: 03/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8260 W FLAGLER ST STE 26
MIAMI FL
33144-2069
US

IV. Provider business mailing address

8260 W FLAGLER ST STE 26
MIAMI FL
33144-2069
US

V. Phone/Fax

Practice location:
  • Phone: 786-300-2323
  • Fax: 305-221-5665
Mailing address:
  • Phone: 786-783-3434
  • Fax: 305-221-5665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DIANELYS MOURELLES CABRERA
Title or Position: PRESIDENT
Credential:
Phone: 786-300-2323