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General NPI Number Information
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NPI Number | 1407662448
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Entity Type | Organization
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Legal Business Name | MAKE WAY 4 HEALTH MEDICAL CENTER LLC
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Dates
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Enumeration Date | 12/04/2024
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Last Update Date | 12/05/2024
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Provider Practice Location Address
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Address Line | 9773 NW 31ST ST
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City | DORAL
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State | FL
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Zip | 33172-1014
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Country | US
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Telephone | 929-274-3536
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Fax |
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Provider Business Mailing Address
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Address Line | 9773 NW 31ST ST
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City | DORAL
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State | FL
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Zip | 33172-1014
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | ARIEL GALLANOSA
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Credential | DO
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Telephone | 929-274-3536
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 202D00000X
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Taxonomy Name | Integrative Medicine Physician
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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