Healthcare Provider Details

I. General information

NPI: 1518700889
Provider Name (Legal Business Name): RHEUMATOLOGY WELLNESS CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2024
Last Update Date: 07/03/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3149 N PONCE DE LEON BLVD STE 1
ST AUGUSTINE FL
32084-8626
US

IV. Provider business mailing address

3149 N PONCE DE LEON BLVD STE 1
ST AUGUSTINE FL
32084-8626
US

V. Phone/Fax

Practice location:
  • Phone: 904-594-2424
  • Fax: 904-594-2425
Mailing address:
  • Phone: 904-594-2424
  • Fax: 904-594-2425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAVID JIMENEZ CIFUENTES
Title or Position: MANAGER
Credential:
Phone: 954-790-9448