MEDICARE: ENDOCRINOLOGY WELLNESS INSTITUTE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM2500X	Medical Specialty Clinic/Center	ME100283	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083020895
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENDOCRINOLOGY WELLNESS INSTITUTE

Provider Business Mailing Address
First Line	:	550 SE 6TH AVE # 200X
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33483-5306
Country	:	US
Telephone Number	:	561-600-2408
Fax Number	:	561-600-2414

Provider Business Practice Location Address
First Line	:	550 SE 6TH AVE # 200X
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33483-5306
Country	:	US
Telephone Number	:	561-600-2408
Fax Number	:	561-600-2414

Authorized Official
Title or Position	:	PRESIDENT
Name	:	VANESSA RODRIGUEZ
Credential	:	MD
Telephone Number	:	765-404-4136

Provider Enumeration Date	:	07/01/2014
Last Update Date	:	10/02/2024

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