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General NPI Number Information
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NPI Number | 1114733631
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Entity Type | Organization
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Legal Business Name | DIAMOND WELLNESS & MED CENTER LLC
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Dates
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Enumeration Date | 12/09/2024
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 1470 NW 107TH AVE STE M
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City | SWEETWATER
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State | FL
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Zip | 33172-2735
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Country | US
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Telephone | 786-439-6017
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Fax |
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Provider Business Mailing Address
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Address Line | 1470 NW 107TH AVE STE M
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City | SWEETWATER
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State | FL
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Zip | 33172-2735
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Country | US
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Telephone | 786-439-6017
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MS. MONICA PATRICIA PEREZ PENA
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Credential | MGR
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Telephone | 786-439-6017
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State |
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Taxonomy #8
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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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