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General NPI Number Information
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NPI Number | 1821423138
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Entity Type | Organization
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Legal Business Name | WELLNESS CLINICAL CENTER, INC
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Dates
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Enumeration Date | 09/05/2013
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Last Update Date | 09/05/2013
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Provider Practice Location Address
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Address Line | 11285 SW 211TH ST SUITE 205
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City | MIAMI
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State | FL
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Zip | 33189-2211
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Country | US
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Telephone | 786-227-5000
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Fax | 305-378-9968
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Provider Business Mailing Address
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Address Line | 11285 SW 211TH ST SUITE 205
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City | MIAMI
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State | FL
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Zip | 33189-2211
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Country | US
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Telephone | 786-227-5000
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Fax | 305-378-9968
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. LISMELYS TRUJILLO GAMA
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Credential | LMT
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Telephone | 786-227-5000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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