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General NPI Number Information
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NPI Number | 1790155455
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Entity Type | Organization
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Legal Business Name | THE BENJAMIN WELLNESS CENTER SOUTH
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Dates
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Enumeration Date | 10/06/2015
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Last Update Date | 10/06/2015
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Provider Practice Location Address
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Address Line | 10300 SUNSET DR STE #280
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City | MIAMI
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State | FL
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Zip | 33173-3012
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Country | US
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Telephone | 305-901-2209
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Fax | 305-901-2189
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Provider Business Mailing Address
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Address Line | 10300 SUNSET DR STE #280
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City | MIAMI
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State | FL
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Zip | 33173-3012
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Country | US
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Telephone | 305-901-2209
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Fax | 305-901-2189
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Authorized Official
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Title or Position | DIRECTOR OF OPERATION
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Name | ILNISE MATHIEU
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Credential |
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Telephone | 954-251-0267
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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