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General NPI Number Information
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NPI Number | 1619574092
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Entity Type | Organization
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Legal Business Name | TAMIAMI WELLNESS CLUB
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Dates
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Enumeration Date | 10/08/2020
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Last Update Date | 10/22/2021
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Provider Practice Location Address
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Address Line | 14255 SW 42ND ST # B-13
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City | MIAMI
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State | FL
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Zip | 33175-6408
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Country | US
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Telephone | 305-982-8771
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Fax | 305-402-6110
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Provider Business Mailing Address
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Address Line | 14255 SW 42ND ST 13B
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City | MIAMI
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State | FL
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Zip | 33175-6408
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Country | US
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Telephone | 305-982-8771
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Fax | 305-402-6110
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Authorized Official
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Title or Position | MANAGER
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Name | SIRAMAD SAINZ
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Credential | MA
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Telephone | 305-982-8771
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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