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General NPI Number Information
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NPI Number | 1720456676
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Entity Type | Organization
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Legal Business Name | MIAMI MEDICAL & WELLNESS CENTER LLC
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Dates
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Enumeration Date | 09/09/2015
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Last Update Date | 09/10/2015
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Provider Practice Location Address
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Address Line | 7500 SW 8TH ST SUITE 103
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City | MIAMI
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State | FL
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Zip | 33144-4400
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Country | US
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Telephone | 305-534-0076
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Fax | 305-735-6471
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Provider Business Mailing Address
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Address Line | 1200 ALTON RD
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City | MIAMI BEACH
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State | FL
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Zip | 33139-3810
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Country | US
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Telephone | 305-534-0076
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Fax | 305-907-5442
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. RODOLFO DUMENIGO JR.
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Credential | M.D
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Telephone | 305-534-0076
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | ME58111
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License Number State | FL
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