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General NPI Number Information
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NPI Number | 1124856794
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Entity Type | Organization
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Legal Business Name | WOMEN'S WELLNESS MD, LLC
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Dates
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Enumeration Date | 07/24/2024
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Last Update Date | 07/24/2024
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Provider Practice Location Address
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Address Line | 7615 BANYAN WAY
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City | TAMARAC
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State | FL
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Zip | 33321-2616
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Country | US
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Telephone | 954-599-8127
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Fax |
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Provider Business Mailing Address
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Address Line | 10222 ARBOR SIDE DR
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City | TAMPA
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State | FL
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Zip | 33647-2951
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Country | US
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Telephone | 954-612-7709
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MARCOS VALENTINO MARTINEZ
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Credential |
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Telephone | 954-512-7709
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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