Provider Demographics
NPI:1033395041
Name:WELLNESS MEDICAL CLINIC AND GERIATRIC CENTER INC
Entity Type:Organization
Organization Name:WELLNESS MEDICAL CLINIC AND GERIATRIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:YAVIR
Authorized Official - Middle Name:M
Authorized Official - Last Name:ESCOVAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-392-9993
Mailing Address - Street 1:12741 MIRAMAR PKWY
Mailing Address - Street 2:BUILDING 2, SUITE 104
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-2903
Mailing Address - Country:US
Mailing Address - Phone:954-392-9993
Mailing Address - Fax:954-392-5559
Practice Address - Street 1:12741 MIRAMAR PKWY
Practice Address - Street 2:BUILDING 2, SUITE 104
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-2903
Practice Address - Country:US
Practice Address - Phone:954-392-9993
Practice Address - Fax:954-392-5559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-21
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME73704261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care