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General NPI Number Information
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NPI Number | 1366850984
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Entity Type | Organization
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Legal Business Name | ENDOCRINOLOGY WELLNESS INSTITUTE
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Dates
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Enumeration Date | 07/28/2014
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Last Update Date | 07/28/2014
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Provider Practice Location Address
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Address Line | 7545 BOYNTON BEACH BLVD SUITE 102
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City | BOYNTON BEACH
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State | FL
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Zip | 33437-6166
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Country | US
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Telephone | 765-404-4136
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Fax | 954-111-1111
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Provider Business Mailing Address
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Address Line | 1643 E CLASSICAL BLVD
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City | DELRAY BEACH
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State | FL
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Zip | 33445-1204
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Country | US
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Telephone | 765-404-4136
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Fax | 954-111-1111
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Authorized Official
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Title or Position | PRESIDENT/PHYSICIAN
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Name | VANESSA RODRIGUEZ
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Credential | M.D.
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Telephone | 765-404-4136
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | ME100283
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License Number State | FL
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