MEDICARE: ALLURE MEDICAL AND WELLNESS CARE, LLC

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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1316715345
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLURE MEDICAL AND WELLNESS CARE, LLC

Provider Business Mailing Address
First Line	:	6193 NW 183RD ST # 173186
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-6030
Country	:	US
Telephone Number	:	305-494-4415
Fax Number	:

Provider Business Practice Location Address
First Line	:	7603 DAVIE ROAD EXT
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-2623
Country	:	US
Telephone Number	:	305-494-4415
Fax Number	:

Authorized Official
Title or Position	:	OWNER / AGENT
Name	:	DR. REGINE DORVIL
Credential	:	MD
Telephone Number	:	305-494-4415

Provider Enumeration Date	:	12/19/2023
Last Update Date	:	12/19/2023

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