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General NPI Number Information
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NPI Number | 1902668536
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Entity Type | Organization
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Legal Business Name | BWELL MED CENTER CORP
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Dates
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Enumeration Date | 01/29/2024
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Last Update Date | 01/29/2024
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Provider Practice Location Address
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Address Line | 10500 NW 26TH ST STE A102A
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City | DORAL
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State | FL
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Zip | 33172-2158
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Country | US
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Telephone | --
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Fax |
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Provider Business Mailing Address
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Address Line | 10500 NW 26TH ST STE A102A
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City | DORAL
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State | FL
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Zip | 33172-2158
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Country | US
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Telephone | 305-364-5182
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CESAR PEREZ
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Credential | MD
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Telephone | --
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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