Healthcare Provider Details

I. General information

NPI: 1265662498
Provider Name (Legal Business Name): WELLMAX HEALTH MEDICAL CENTERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2009
Last Update Date: 03/03/2021
Certification Date: 02/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 SOUTH HIATUS ROAD (1-9)
PEMBROKE PINES FL
33025
US

IV. Provider business mailing address

9250 W FLAGLER ST STE 600
MIAMI FL
33174-3460
US

V. Phone/Fax

Practice location:
  • Phone: 954-438-4000
  • Fax: 954-438-6000
Mailing address:
  • Phone: 305-448-8100
  • Fax: 305-444-9148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. VANESSA VILLALI
Title or Position: DIRECTOR PRACTICE MANAGEMENT
Credential:
Phone: 305-586-7288