MEDICARE: DMA WELLNESS CENTER CORP.

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	2084B0040X	Behavioral Neurology & Neuropsychiatry Physician
2	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1417815689
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DMA WELLNESS CENTER CORP.

Provider Business Mailing Address
First Line	:	3430 E FLAMINGO RD STE 307
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5066
Country	:	US
Telephone Number	:	786-752-0846
Fax Number	:	702-846-4112

Provider Business Practice Location Address
First Line	:	3430 E FLAMINGO RD STE 307
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5066
Country	:	US
Telephone Number	:	786-752-0846
Fax Number	:	702-846-4112

Authorized Official
Title or Position	:	MANAGING DIRECTOR
Name	:	DAGMAR DE LA CRUZ
Credential	:
Telephone Number	:	786-752-0846

Provider Enumeration Date	:	01/14/2026
Last Update Date	:	01/20/2026

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Directions to “DMA WELLNESS CENTER CORP. ” Practice Location

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