=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346060522
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PASTEUR & WELLMAX MEDICAL CENTERS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/14/2024
-----------------------------------------------------
Last Update Date | 11/27/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11510 QUAIL ROOST DR
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33157-6548
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-256-3056
-----------------------------------------------------
Fax | 305-256-3066
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6355 NW 36TH ST EAST BUILDING, SUITE 1100
-----------------------------------------------------
City | VIRGINIA GARDENS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33166
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-233-6981
-----------------------------------------------------
Fax | 786-322-2317
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | JORGE RAAD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 786-233-6981
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------