Healthcare Provider Details

I. General information

NPI: 1700692670
Provider Name (Legal Business Name): ZAMZAM WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2024
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S ORLANDO AVE STE 210
WINTER PARK FL
32789-5543
US

IV. Provider business mailing address

1400 S ORLANDO AVE STE 210
WINTER PARK FL
32789-5543
US

V. Phone/Fax

Practice location:
  • Phone: 407-409-8807
  • Fax: 407-557-4885
Mailing address:
  • Phone: 407-409-8807
  • Fax: 407-557-4885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DOMINIQUE DILORENZO
Title or Position: OWNER/ PHYSICIAN
Credential: MD
Phone: 407-409-8807