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General NPI Number Information
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NPI Number | 1104524354
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Entity Type | Organization
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Legal Business Name | CELLMAX MEDICAL GROUP, CORP
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Dates
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Enumeration Date | 02/17/2023
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Last Update Date | 02/21/2023
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Provider Practice Location Address
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Address Line | 17699 NW 78TH AVE
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City | HIALEAH
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State | FL
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Zip | 33015-3627
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Country | US
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Telephone | 786-487-6626
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Fax |
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Provider Business Mailing Address
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Address Line | 17699 NW 78TH AVE
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City | HIALEAH
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State | FL
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Zip | 33015-3627
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Country | US
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Telephone | 786-487-6626
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | YESIRA BASSI
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Credential |
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Telephone | 786-487-6626
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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